Matteo Foschi: ASPERA-R Reveals the Challenges of Anticoagulation Resumption After Hemorrhagic Transformation
Matteo Foschi, Senior Consultant Neurologist at Romagna Local Health Authority (AUSL Romagna), shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in International Journal of Stroke, adding:
“A stroke despite anticoagulation.
Then hemorrhagic transformation (HT).
When is it safe to restart?
One of the toughest decisions in stroke care becomes even more complicated when ischemia and bleeding collide.
While ELAN provided important evidence on early versus late DOAC initiation after AF-related stroke, patients experiencing breakthrough stroke despite anticoagulation remain underrepresented…
Out today in the International Journal of Stroke!
1,555 patients, including 269 (17.3 percent) with hemorrhagic transformation from the ASPERA-R cohort.
Study co-led by Lucio D’Anna, Prof Simona Sacco and myself.
HT was associated with substantially worse 90-day outcomes, including nearly double the mortality (34.2 percent versus 17.7 percent).
After anticoagulation resumption, HT remained associated with a more than threefold higher bleeding risk, but not with a statistically significant increase in recurrent ischaemic events.
And the million-dollar question: WHEN to restart?
Our exploratory modelling identified the lowest predicted combined ischaemic–bleeding risk at approximately 10 days, with later estimates in patients with parenchymal haematoma and more severe strokes.
There is probably no single clock for every patient.
HT subtype and stroke severity matter…”
Title: Haemorrhagic Transformation in Breakthrough Ischemic Stroke: Clinical Characteristics, Outcomes, and Anticoagulation Resumption Timing—Insights from the ASPERA-R Study
Authors: Lucio D’Anna, Matteo Foschi, Francesca Gabriele, Raffaele Ornello, Andrea Zini, Matteo Paolucci, Stefano Forlivesi, Mauro Gentile, Giacomo Urbinati, Angelo Cascio Rizzo, Maria Sessa, Ghil Schwarz, Rachele Tortorella, Gabriele Prandin, Ludovica Maria Miserocchi, Giorgia Balducci, Gaurav Desai, Leonardo Pantoni, Francesco Mele, Giuseppe Scopelliti, Ilaria Cova, Mariarosaria Valente, Giovanni Merlino, Domenico Maisano, Luca Antonelli, Maria Rosaria Bagnato, Giovanni Di Mauro, Francesca Bernocchi, Martina Gaia Di Donna, Barbara Casolla, Stephan Mbakop-Noukoua, Paolo Arnoffi, Sok-Sithikun Bun, Laura Gonzalez-Martín, 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 Mohamed Ahmed, Samah Ali Ismail, Liqun Zhang, Tara Latimer, Muhammad Elboghdany, Ahmed Elbassiouny, Tamer Roushdy, Hossam M Shokri, Federica Ferrari, Nicola Loizzo, Federico Mazzacane, Maria Guarino, 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 Gaspar Fonseca, Bernardo Antunes, Hrvoje Budinčević, Petra Crnac, Giovanna Viticchi, Mauro Silvestrini, Viktoria Musienko, Samir Abu-Rumeileh, Lorenzo Barba, Markus Otto, Piergiorgio Lochner, Benjamin Landau, Sandeep Buddha, Roumeisa Khalil, Maria Grazia Piscaglia, Marialuisa Zedde, Ahmed Nasreldein, Luisa Vinciguerra, Luís Rufo Costa, Ahmed Elsayed, Mona AlBanna, Laura Tudisco, Maria Giulia Mosconi, Federico De Santis, Simona Sacco
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