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CC BY 4.0 · Thromb Haemost 2026; 126(01): 005-010
DOI: 10.1055/a-2576-7760
Invited Clinical Focus

Personalized Medicine, Public Health and Patient-Centred Aspects in the Prevention of Stroke in Intracerebral Haemorrhage Survivors with Atrial Fibrillation (PRESTIGE-AF) Project

Authors

  • Kirsten H. Harvey

    1   Department of Brain Sciences, Imperial College London, London, United Kingdom

  • Eleni Korompoki

    1   Department of Brain Sciences, Imperial College London, London, United Kingdom
    2   Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece

  • Emily R. Harvey

    1   Department of Brain Sciences, Imperial College London, London, United Kingdom

  • Cornelia Fießler

    3   Clinical Trial Center Wüzburg, University Hospital Würzburg, Würzburg, Germany

  • Uwe Malzahn

    3   Clinical Trial Center Wüzburg, University Hospital Würzburg, Würzburg, Germany

  • Klemens Hügen

    3   Clinical Trial Center Wüzburg, University Hospital Würzburg, Würzburg, Germany

  • Sabine Ullmann

    3   Clinical Trial Center Wüzburg, University Hospital Würzburg, Würzburg, Germany

  • Carolin Schuhmann

    3   Clinical Trial Center Wüzburg, University Hospital Würzburg, Würzburg, Germany

  • Gabriele Putz Todd

    3   Clinical Trial Center Wüzburg, University Hospital Würzburg, Würzburg, Germany

  • Joan Montaner

    4   Department of Neurology, Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Hospital Universitario Virgen Macarena, Seville, Spain
    5   Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Barcelona, Spain

  • Anna Penalba

    5   Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Barcelona, Spain

  • Daisy Guaman-Pilco

    5   Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Barcelona, Spain

  • Igor Sibon

    6   University of Bordeaux, UMR-CNRS 5287, INCIA, Bordeaux, France
    7   Stroke Unit, Bordeaux University Hospital, Bordeaux, France

  • Stephanie Debette

    8   UMR 1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
    9   Department of Neurology, Institute for Neurodegenerative Diseases, Bordeaux University Hospital, Bordeaux, France

  • Timothy D'Aoust

    8   UMR 1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France

  • Morgane Lachaize

    8   UMR 1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
    9   Department of Neurology, Institute for Neurodegenerative Diseases, Bordeaux University Hospital, Bordeaux, France

  • Christian Enzinger

    10   Department of Neurology, Medical University of Graz, Graz, Austria

  • Stefan Ropele

    10   Department of Neurology, Medical University of Graz, Graz, Austria

  • Simon Fandler-Höfler 

    10   Department of Neurology, Medical University of Graz, Graz, Austria

  • Viktoria Ruecker

    11   Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany

  • Kirsten Haas

    11   Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany

  • Peter B. Nielsen

    12   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
    13   Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark

  • Charles Wolfe

    14   School of Life Course and Population Sciences, King's College London, London, United Kingdom
    15   NIHR Applied Research Collaboration (ARC) South London, London, United Kingdom

  • Yanzhong Wang

    14   School of Life Course and Population Sciences, King's College London, London, United Kingdom

  • Hatem Wafa

    14   School of Life Course and Population Sciences, King's College London, London, United Kingdom

  • Valeria Caso

    16   Stroke Unit - Internal, Vascular and Emergency Medicine, University of Perugia, Santa Maria della Misericordia Hospital Perugia, Perugia, Italy

  • Maria Giulia Mosconi

    16   Stroke Unit - Internal, Vascular and Emergency Medicine, University of Perugia, Santa Maria della Misericordia Hospital Perugia, Perugia, Italy

  • Gregory Y. H. Lip 

    13   Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
    17   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom

  • Deirdre A. Lane 

    13   Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
    17   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
    18   Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom

  • Walter E. Haefeli

    19   Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
    20   Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany

  • Kathrin I. Foerster

    20   Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany

  • Viktoria S. Wurmbach

    19   Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
    20   Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany

  • Peter Ringleb

    21   Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany

  • Peter U. Heuschmann

    3   Clinical Trial Center Wüzburg, University Hospital Würzburg, Würzburg, Germany
    11   Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
    23   Institute for Medical Data Science, University Hospital Würzburg, Germany

  • Roland Veltkamp

    1   Department of Brain Sciences, Imperial College London, London, United Kingdom
    21   Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
    22   Department of Neurology, Alfried-Krupp Krankenhaus Essen Germany
    • on behalf of PRESTIGE-AF investigators
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Introduction

Although systematic reviews and meta-analysis of observational studies have suggested a benefit of oral anticoagulation (OAC) for ischaemic stroke prevention without a significant increase in recurrent ICH, experts agree that more evidence is required from randomized controlled trials (RCTs).[1] [2] PRESTIGE-AF is a European Union Horizon 2020 funded project with a consortium of 12 institutions across 7 countries since 2019 ([Fig. 1]). The aim is to explore optimal stroke prevention strategies for intracerebral haemorrhage (ICH) survivors with atrial fibrillation (AF), investigating the balance between the risk of ischaemic stroke against the risk of recurrent ICH.

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Fig. 1 PRESTIGE-AF consortium institutions.

The complexity of clinical management in ICH patients with AF is compounded by differences in clinical and patient characteristics, such as stroke severity, risk factors, and socio-demographics. Consequently, it is unlikely that RCTs alone will provide a solution for stroke prevention that will fit individual patients. Therefore, in addition to the main RCT, PRESTIGE-AF is examining how blood-based biomarkers, genetic factors, neuroimaging, and clinical features can be used to personalize stroke management. We are also exploring patient-centred aspects which can influence medication use and clinical trial participation. The project overview is shown in [Fig. 2]. Clinical trial results can have a broad impact on health policy. This will be addressed within the project by modelling the health economic impact of our results and exploring if our findings are generalizable to a European population.

Zoom
Fig. 2 PRESTIGE-AF project overview.

The review process for this paper was fully handled by Christian Weber, Editor in Chief.




Publication History

Received: 11 December 2024

Accepted: 04 March 2025

Article published online:
30 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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