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Matteo Foschi: Is There a Benefit to Switching DOACs After Breakthrough Stroke?
Matteo Foschi/LinkedIn
Apr 29, 2026, 07:12

Matteo Foschi: Is There a Benefit to Switching DOACs After Breakthrough Stroke?

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

”Another great achievement for the ASPERA-R collaboration!

Just published in JAMA Network Open

What should we do after a breakthrough ischemic stroke in patients already on DOACs?

Using an emulated target trial design, we tried to get as close as possible to randomized evidence in a real-world setting.

Key results:

  • In >1000 patients with AF and breakthrough stroke,

Switching anticoagulation was NOT superior to continuing the same DOAC

  • Net clinical benefit at 90 days was essentially identical (4.9% vs 5.1%; RD −0.3%)

No meaningful differences in:

  • recurrent ischemic events
  • intracranial hemorrhage
  • major bleeding

No clear signal even when switching mechanism (factor Xa to thrombin inhibitor)

Noninferiority not formally shown for mortality – still an open question

Take-home message:

The common reflex of ‘switching after failure’ may not be evidence-based

Continuation might be a simpler and equally effective strategy in most patients

Huge thanks to all collaborators across 35 centers and multiple countries… teamwork at its best!”

Title: Continuation vs Switching Direct Oral Anticoagulant Therapy After Breakthrough Stroke

Authors: Lucio D’Anna, Francesca Gabriele, Raffaele Ornello, Andrea Zini, Matteo Paolucci, Stefano Forlivesi, Ludovica Migliaccio, Maria Maddalena Viola, Angelo Cascio Rizzo, Maria Sessa, Ghil Schwarz, Rachele Tortorella, Gabriele Prandin, Soma Banerjee, Gurav Desai, Leonardo Pantoni, Francesco Mele, Giuseppe Scopelliti, Ilaria Cova, Mariarosaria Valente, Domenico Maisano, Maria Rosaria Bagnato, Giovanni Di Mauro, Francesca Bernocchi, Martina Gaia Di Donna, Barbara Casolla, Marie-Helene Mahagne, Marie-Eve Amoretti, Lucille Morgan, Laura González, Ricardo Rigual, Blanca Fuentes, Carlos Hervás, 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 Elboghday, Ahmed El Bassiouny, Tamer Roushdy, Hossam Shokri, Federica Ferrari, Nicola Davide Loizzo, Federico Mazzacane, Maria Guarion, Valentina Barone, Paola Forti, Giuseppe Rinaldi, Marco Rossi, Vincenzo Laterza, Giovanni Frisullo, Pier Andrea Rizzo, Aldobrando Broccolini, Marina Mannino, Valeria Terruso, Marcella Caggiula, Simona Scalise, Ana Catarina Fonseca, Bernardo Antunes, Hrvoje Budincevic, Petra Crnac, Giovanna Viticchi, Mauro Silvestrini, Lorenzo Barba, Viktoria Musienko, Piergiorgio Lochner, Benjamin Landau, Sandeep Buddha, Roumeisa Khalil, Maria Grazia Piscaglia, Elena Minguzzi, Marialuisa Zedde, Ahmed Nasreldein, Luisa Vinciguerra, Luis Costa, Ahmed Elsaid Elsayed, Mona Al Banna, Laura Tudisco, Maria Giulia Mosconi, Giovanni Merlino, Federico De Santis, Simona Sacco, Matteo Foschi

Matteo Foschi: Is There a Benefit to Switching DOACs After Breakthrough Stroke?

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