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Matteo Foschi: ASPERA-R Study Reveals Competing Causes Of Breakthrough Stroke On Anticoagulation
Matteo Foschi/LinkedIn
Apr 14, 2026, 15:05

Matteo Foschi: ASPERA-R Study Reveals Competing Causes Of Breakthrough Stroke On Anticoagulation

Matteo Foschi, Neurologist at Azienda USL della Romagna, Affiliated Researcher at the Cochrane MS and Rare Diseases of the CNS Review Group, shared a post on LinkedIn about a recent article he and his colleagues co-authored, adding:

“New in Neurology – ASPERA-R Study

Breakthrough stroke on anticoagulation is not just cardioembolism

In a large real-world multicenter cohort (1,649 patients):

  •  1 in 4 patients had competing stroke etiologies
  • Mostly large artery atherosclerosis

Key outcomes (90 days)

Compared with ‘pure’ AF-related stroke:

  • Recurrent stroke results in adjusted hazard ratio (aHR) 2.62
  • Worse disability (modified Rankin Scale shift) corresponds to adjusted odds ratio (aOR) 1.30
  • Higher mortality corresponds to adjusted hazard ratio (aHR) 1.58
  • More bleeding corresponds to adjusted hazard ratio (aHR) 1.82

A consistent pattern: worse outcomes across all domains

Why this matters

  • We are likely oversimplifying a substantial proportion of strokes on OAC

These are often multimechanistic events, not simple ‘anticoagulation failures’

Clinical implication

  • Go beyond AF and search for competing mechanisms.
  • Rethink secondary prevention: one-size-fits-all is not enough.

Great achievement for the ASPERA International collaboration!!! (prospective arm is ongoing…)

Let’s discuss these findings at ESOC 2026 – Maastricht

A9 – Competing etiologies and outcomes after breakthrough ischemic stroke on oral anticoagulants

Sydney, Thursday, 7 May, 15:15 – 15:25 CEST.”

Title: Competing Stroke Etiologies and Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants in Patients With Atrial Fibrillation

Authors: Matteo Foschi, Federico De Santis, Francesca Gabriele, Raffaele Ornello, Lucio D’Anna, Andrea Zini, Matteo Paolucci, Stefano Forlivesi, Ludovica Migliaccio, Maria Maddalena Viola, Angelo Cascio Rizzo, Maria Sessa, Ghil Schwarz, Rachele Tortorella, Soma Banerjee, Gaurav Desai, Kazi Farhad Ahmed, Gabriele Prandin, Leonardo Pantoni, Francesco Mele, Giuseppe Scopelliti, Ilaria Cova, Mariarosaria Valente, Domenico Maisano, Luca Antonelli, Maria Rosaria Bagnato, Giovanni Di Mauro, Francesca Bernocchi, Martina Gaia Di Donna, Barbara Casolla, Perla Mazloum, Corrado Campisi, Agathe Caraux, Laura González-Martín, Ricardo Rigual, Blanca Fuentes, Carlos Hervás-Testal, Paolo Candelaresi, Vincenzo Andreone, Antonio De Mase, Emanuele Spina, Diana Aguiar De Sousa, Mariana Almudi Souza, Alberto Fior, Miguel Serôdio, Pietro Caliandro, Aurelia Zauli, Giuseppe Reale, Ahmed Abdelalim, Sandra Ahmed, Samah Ali Ismail, Liqun Zhang, Tara Latimer, Muhammad Elboghdady, Ahmed Elbassiouny, Tamer Roushdy, Hossam Shokri, Federica Ferrari, Nicola D. Loizzo, Federico Mazzacane, Maria Guarino, Valentina Barone, Paola Forti, Giuseppe Rinaldi, Marco Vito Rossi, Vincenzo Laterza, Giovanni Frisullo, Pier Andrea Rizzo, Aldobrando Broccolini, Marina Mannino, Valeria Terruso, Marcella Caggiula, Annalisa Rizzo, Ana Catarina Fonseca, Bernardo Antunes, Ana M. Barbosa, Hrvoje Budincevic, Petra Crnac, Giovanna Viticchi, Mauro Silvestrini, Lorenzo Barba, Viktoria Musienko, Markus Otto, Piergiorgio Lochner, Benjamin Landau, Sandeep Buddha, Roumeisa Khalil, Maria Grazia Piscaglia, Elena Minguzzi, Marialuisa Zedde, Ahmed Nasreldein, Luisa Vinciguerra, Luis Rufo Costa, Ahmed Elsaid Elsayed, Mona AlBanna, Laura Tudisco, Maria Giulia Mosconi, Alexandros A. Polymeris, Giovanni Merlino, Simona Sacco

Read the Full Article on Neurology

Matteo Foschi: ASPERA-R Study Reveals Competing Causes Of Breakthrough Stroke On Anticoagulation

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Agathe Caraux Ahmed Abdelalim Ahmed Elbassiouny Ahmed Elsaid Elsayed Ahmed Nasreldein Alberto Fior Aldobrando Broccolini Alexandros A. Polymeris Ana Catarina Fonseca Ana M Barbosa Andrea Zini Angelo Cascio Rizzo Annalisa Rizzo Antonio De Mase ASPERA-R Study Aurelia Zauli Barbara Casolla Benjamin Landau Bernardo Antunes Blanca Fuentes Carlos Hervás-Testal Corrado Campisi Diana Aguiar de Sousa Domenico Maisano Elena Minguzzi Emanuele Spina ESOC 2026 European Stroke Organisation Federica Ferrari Federico De Santis Federico Mazzacane Francesca Bernocchi Francesca Gabriele Francesco Mele Gabriele Prandin Gaurav Desai Ghil Schwarz Giovanna Viticchi Giovanni Di Mauro Giovanni Frisullo Giovanni Merlino Giuseppe Reale Giuseppe Rinaldi Giuseppe Scopelliti Health Hematology Hemostasis Hemostasis News Hemostasis Today Hossam Shokri Hrvoje Budincevic Ilaria Cova Kazi Farhad Ahmed Laura González-Martín Laura Tudisco Leonardo Pantoni Liqun Zhang Lorenzo Barba Luca Antonelli Lucio D’Anna Ludovica Migliaccio Luis Rufo Costa Luisa Vinciguerra Marcella Caggiula Marco Vito Rossi Maria Giulia Mosconi Maria Grazia Piscaglia Maria Guarino Maria Maddalena Viola Maria Rosaria Bagnato Maria Sessa Marialuisa Zedde Mariana Almudi Souza Mariarosaria Valente Marina Mannino Markus Otto Martina Gaia Di Donna Matteo Foschi Matteo Paolucci Mauro Silvestrini Medicine Miguel Serôdio Mona AlBanna Muhammad Elboghdady Neurology Nicola D. Loizzo Paola Forti Paolo Candelaresi Perla Mazloum Petra Crnac Pier Andrea Rizzo Piergiorgio Lochner Pietro Caliandro Rachele Tortorella Raffaele Ornello Ricardo Rigual Roumeisa Khalil Samah Ali Ismail Sandeep Buddha Sandra Ahmed Simona Sacco Soma Banerjee Stefano Forlivesi Tamer Roushdy Tara Latimer Valentina Barone Valeria Terruso Viktoria Musienko Vincenzo Andreone Vincenzo Laterza
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