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
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