30% of People Have More Than One Stroke-But an Exciting New Development Could Reduce Recurrence Chances
Every 40 seconds, someone in the U.S. has a stroke. It's one of the most serious health events someone can experience and can have debilitating consequences. Having one stroke is scary and life-threatening enough. But according to the Centers for Disease Control and Prevention, nearly one in four strokes are repeat strokes, which means the person experiencing it has had a stroke before.
According to a study published in Stroke, secondary strokes carry a significantly higher risk of disability or mortality than first-time events. This means if you've had a stroke, doing everything you can to prevent having a second one is really important.
Related: The Unexpected Stroke Sign Most People Miss, According to a Vascular Neurologist
After someone has a stroke, their doctor will typically prescribe them a medication such as a blood thinner or statin to prevent a secondary stroke. But considering how common repeat strokes still are, there's certainly room for improvement when it comes to treatment.
It's exactly what makes new, groundbreaking research out of the Cleveland Clinic so exciting. Parade talked with Dr. Andrew Russman, DO, the head of the stroke program and medical director of the Comprehensive Stroke Center at the Cleveland Clinic, to learn more.
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How New Research Is Shaping the Future of Secondary Stroke Prevention
Did you know that some people are at a lower risk of ever having a stroke due to their genetics? It's true. Dr. Russman explains that people with low levels of a blood-clotting protein called factor XI are at a significantly reduced risk of having a stroke.
With this in mind, Dr. Russman says that researchers identified factor XI as a potential target for secondary stroke prevention. "The idea was that we could find a way to reduce the risk of stroke without increasing the risk of bleeding," he says. Dr. Russman explains that the risk of bleeding is a primary concern for taking a blood thinner or aspirin, which is what's commonly advised after a stroke.
This line of thinking proved to be spot on. Researchers used this intel to develop asundexian, a new oral medication that a large clinical trial shows reduces the risk of secondary stroke without increasing the risk of bleeding.
Unlike traditional oral anticoagulants like rivaroxaban and apixaban, asundexian works by binding to an enzyme called FXIa. This prevents FXIa from activating factor XI, lowering the amount of factor XI in the body. This helps lower the risk of stroke without increasing the risk of spontaneous bleeding, which is a risk factor for taking aspirin or anticoagulants.
Dr. Russman says that a clinical trial taking into account more than 12,000 people found that the relative risk reduction with asundexian was 26% when compared to a placebo.
He explains that it's been decades since a medication that can be used for stroke prevention has come out, which is what makes the trial on asundexian so exciting.
"One important characteristic about asundexian is that it's shown to help with stroke prevention both in the short-term and long-term," Dr. Russman says. He explains that current medications used for secondary stroke prevention only seem to help in the short-term and not the long-term, which is why this is so noteworthy.
When Will the Medication Come Out?
The trial with asundexian wrapped up in the fall of 2025 and the results were published in The New England Journal of Medicine last month. Currently, the drug is being manufactured by Bayer and has been submitted for fast-track approval by the Food and Drug Administration.
"I'm told that they anticipate hearing from the FDA soon and, if approved, the drug could be available in early 2027," Dr. Russman says.
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Dr. Russman reveals that there are a couple of other drugs that work similarly to asundexian being developed too, though the data from their clinical trials has not yet been released. Considering that strokes are one of the top causes of death in the U.S., the development of new potential treatments is certainly noteworthy.
While medication plays an important role in stroke prevention, Dr. Russman emphasizes that having healthy diet and lifestyle habits in place matters too. This means avoiding tobacco use, following a balanced, nutrient-rich diet, getting regular exercise and consistently getting enough sleep.
These habits are the cornerstones of good health, and their impact matters more than any drug you can take. But just think about how powerful their impact could be when combined.
Up Next:
Related: This Common Heart Condition Can Cause a Stroke, Cardiologists Warn
Sources:
- Stroke Facts. Center for Disease Control and Prevention.
- Hardie, K., Hankey, G. J., Jamrozik, K., et al. (2004). Ten-Year Risk of First Recurrent Stroke and Disability After First-Ever Stroke in the Perth Community Stroke Study. Stroke.https://doi.org/10.1161/01.STR.0000116183.50167.D.
- Dr. Andrew Russman, DO, head of the stroke program and medical director of the Comprehensive Stroke Center at the Cleveland Clinic
- Saloman, O., Steinberg, D. M., Koren-Morag, N., et al. (2008). Reduced incidence of ischemic stroke in patients with severe factor IX deficiency.Blood. 111(8):4113-7.
- Sharma, M., Dong, Q., Hirano, T., et al. (2026). Asundexian for Secondary Stroke Prevention. The New England Journal of Medicine. 394(15):1467-1479.
- Leading Causes of Death. Center for Disease Control and Prevention.
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This story was originally published May 25, 2026 at 11:25 AM.