Matteo Foschi: Sex-Specific Outcomes of Breakthrough Ischemic Stroke Despite Oral Anticoagulation in Atrial Fibrillation
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:
“Sex differences in breakthrough stroke on OAC for AF: beyond a ‘sex-neutral’ approach – American Heart Association.
In our ASPERA-R study (n=1649), focusing on breakthrough ischemic stroke despite oral anticoagulation:
- Women were less likely to recover functional independence at 90 days
- They showed worse overall disability (mRS shift)
- And had a higher risk of recurrent ischemic events
These differences persisted even after rigorous adjustment using inverse probability weighting.
One key signal emerges clearly:
The way we assess thromboembolic risk in atrial fibrillation is evolving, but must remain clinically nuanced.
- Female sex has long been included in the CHA₂DS₂-VASc score as a risk modifier.
- Recent proposals suggest a CHA₂DS₂-VA approach, removing sex to simplify risk stratification.
However, this simplification may overlook clinically relevant heterogeneity across sexes.
Moreover, women showed higher rates of oral anticoagulation discontinuation/interruption after stroke, which may partly explain the increased recurrence risk.
Breakthrough stroke is not just a failure of anticoagulation: it is a complex, multifactorial condition where biology, treatment patterns, and healthcare systems intersect.
Time to move toward truly personalized, sex-informed care.
We are truly grateful and honored by the insightful editorial by Professor Lip and Bernadette Corica accompanying our work.
Thanks to all the ASPERA PIs and collaborators for this outstanding result.”
Title: Sex Differences in Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants for Atrial Fibrillation: An ASPERA-R Inverse Probability Weighted Analysis
Authors: Matteo Foschi, 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, Soma Banerjee, Gaurav Desai, Muhammad Jaffar, 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, Chiara Bruno, Baptiste Alvarez, Laura González-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 Ahmed, Nourhan Mohamed Soliman, Liqun Zhang, Tara Latimer, Muhammad Elboghday, Ahmed Aly Elbassiouny, Tamer Roushdy, Hossam Shokri, Federica Ferrari, Nicola Davide 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, Guglielmo Lucchese, 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 Costa, Ahmed Elsaid Elsayed, Mona AlBanna, Laura Tudisco, Maria Giulia Mosconi, Giovanni Merlino, Alexandros Polymeris, Federico De Santis, Simona Sacco
Read the Full Article on Journal of the American Heart Association.
Title: Breakthrough Stroke in Women With Atrial Fibrillation: A Call for Sex-Specific Care and Better Outcomes
Authors: Bernadette Corica, Gregory Y. H. Lip
Read the Full Article on Journal of the American Heart Association.
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