Abstract
Embolic stroke of undetermined source (ESUS) is a recent subtype of cryptogenic ischemic stroke. ESUS is defined as non-lacunar brain infarct without proximal arterial stenoses or cardioembolic sources with a clear indication for anticoagulation.
Optimal secondary prevention in ESUS according to the current guidelines is antiplatelet treatment. The risk of recurrence is relatively high and therefore the new direct oral anticoagulants (DOAC) are tested in clinical trials.
The article reviews recently published and ongoing studies of DOACs in ESUS patients. Based on available results seems reasonable that the ESUS concept should be refined into three or more distinct categories: ESUS with cardiopathy, ESUS with stenoses of large arteries bellow 50 % and other ESUS patients.
The time of using ESUS concept in daily clinical practice has not yet come, but currently available data could help us guiding in the diagnostic algorithm in patients with undetermined cause of stroke.