, Volume 78, Issue 8, pp 823–831 | Cite as

Management of Embolic Stroke of Undetermined Source (ESUS)

  • Tobias Geisler
  • Annerose Mengel
  • Ulf Ziemann
  • Sven Poli
Review Article


According to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, embolic stroke of undetermined source (ESUS) has refined the old definition of cryptogenic stroke. More sophisticated criteria and a well-defined diagnostic workup point out the embolic nature of this disease. Because ESUS is associated with a high stroke recurrence, a clear risk prediction and management is of utmost importance to improve prognosis. To date, standard pharmacotherapy consists of antiplatelet drugs and statins. This review attempts to provide an overview on the diagnostic criteria, prognosis, and current clinical trials evaluating the value of direct oral anticoagulants for secondary prevention after ESUS.


Compliance with Ethical Standards


No external funding was used in the preparation of this manuscript.

Conflicts of interest

Tobias Geisler reports personal fees from AstraZeneca, Boehringer Ingelheim, Pfizer, and MSD; grants and personal fees from Bayer Healthcare, Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, and The Medicines Company; and grants from Siemens Healthcare and Spartan Bioscience, outside the submitted work. Annerose Mengel has no conflicts of interest relevant to the presented work. Ulf Ziemann has received speaker honoraria and/or travel compensation from Bayer Vital GmbH, Biogen Idec GmbH, Bristol Myers Squibb GmbH, Medtronic GmbH, and Pfizer GmbH; and grants from Biogen Idec GmbH, Servier, and Janssen Pharmaceuticals NV. He serves on the advisory board of CorTec GmbH. None of the above are related to the submitted work. Sven Poli has received speaker’s honoraria and consulting honoraria from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo and Werfen; reimbursement for congress traveling and accommodation from Bayer and Boehringer Ingelheim; and research support from Bristol-Myers Squibb/Pfizer, Boehringer-Ingelheim, Daiichi Sankyo and Helena Laboratories. None of the above are related to the submitted work.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Tobias Geisler
    • 1
  • Annerose Mengel
    • 2
  • Ulf Ziemann
    • 2
  • Sven Poli
    • 2
  1. 1.Department of CardiologyUniversity Hospital TübingenTübingenGermany
  2. 2.Department of Neurology and StrokeUniversity Hospital TübingenTübingenGermany

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