Sex Differences in Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants for Atrial Fibrillation: An ASPERA‐R Inverse Probability Weighted Analysis

BACKGROUND: Sex-specific outcomes after breakthrough ischemic stroke on oral anticoagulation (OAC) are unexplored. We compared 90-day outcomes by sex and explored modifiers. METHODS: ASPERA-R (Advancing Knowledge in Ischemic Stroke Patients on Oral Anticoagulants retrospective cohort; NCT06823466) was an international, multicenter, retrospective study enrolling adults (aged >18 years) with breakthrough ischemic stroke on OAC for atrial fibrillation. Primary outcome was 90-day return to baseline neurologic function (modified Rankin Scale [mRS] score 0-1 maintained if prestroke 0-1; or same/lower mRS score if prestroke ≥2). Secondary outcomes were 90-day mRS shift, recurrent ischemic stroke/transient ischemic attack, myocardial infarction, and all-cause and vascular death. Safety outcomes included 90-day moderate-to-severe bleeding, intracranial hemorrhage, 24-hour hemorrhagic transformation, and 24-hour symptomatic intracranial hemorrhage. We applied inverse probability weighting and regression models to compare outcomes. Prespecified subgroup analysis tested sex-specific interactions. RESULTS: =0.070). Subgroup analyses revealed significant sex interactions for OAC type, competing cause, endovascular treatment, and OAC restart. CONCLUSIONS: Women had worse 90-day outcomes than men after breakthrough ischemic stroke on OAC for atrial fibrillation, highlighting the need for sex-aware management.

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Publication Details

Journal
Journal of the American Heart Association
Published
2026-03-31
DOI
https://doi.org/10.1161/jaha.125.047064
Citations
1
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
Field-Weighted Citation Impact
18.76
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article

Sex Differences in Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants for Atrial Fibrillation: An ASPERA‐R Inverse Probability Weighted Analysis

Valeria Terruso, Guglielmo Lucchese, Mauro Silvestrini, Carlos Hervás et al.
1 citations
Journal of the American Heart Association
Atrial Fibrillation Management and Outcomes
18.76
article

Sex Differences in Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants for Atrial Fibrillation: An ASPERA‐R Inverse Probability Weighted Analysis

Valeria Terruso, Guglielmo Lucchese, Mauro Silvestrini, Carlos Hervás, Giuseppe Scopelliti, Ahmed Abdelalim, Maria Rosaria Bagnato, Rachele Tortorella, Francesca Bernocchi, Alberto Fior, Antonio De Mase, Miguel Serôdio, Luisa Vinciguerra, Paola Forti, Tamer Roushdy, Maria Guarino, Tara Latimer, Maria Sessa, Maria Maddalena Viola, Bernardo Nascimento Antunes, Giovanna Viticchi, P. Caliandro, Pier Andrea Rizzo, Ilaria Cova, Martina Gaia Di Donna, Maria Giulia Mosconi, Mariana A de Souza, Hossam Shokri, Chiara Bruno, Lorenzo Barba, Maria Grazia Piscaglia, Angelo Cascio Rizzo, Luís Cadillon Costa, Matteo Paolucci, Stefano Forlivesi, Gaurav S. Desai, Raffaele Ornello, Barbara Casolla, Markus Otto, Aldobrando Broccolini, Federico De Santis, Nicola Davide Loizzo, Giovanni Di Mauro, Marcella Caggiula, Ahmed Nasreldein, Federico Mazzacane, Vincenzo Laterza, Gabriele Prandin, Laura Gonzalez‐Martin, SOMA BANERJEE, Giuseppe Rinaldi, Ana Catarina Fonseca, Blanca Fuentes, Ahmed Elsayed, Sandeep Buddha, Viktoria Musienko, Simona Sacco, Francesco Mele, Ghil Schwarz, Muhammad Jaffar, Ricardo Rigual, Benjamin Landau, Federica Ferrari, Elena Minguzzi, Roumeisa Khalil, Muhammad Elboghday, Ahmed Aly Elbassiouny, Nourhan Mohamed Soliman, Ana M Barbosa, Marco Vito Rossi, Luca Antonelli, Mona AlBanna, V. Andreone, P Candelaresi, Mariarosaria Valente, Petra Crnac, Diana Aguiar de Sousa, Perla Mazloum, Francesca Gabriele, Liqun Zhang, Sandra Ahmed, Valentina Barone, Matteo Foschi, Andrea Zini, Giovanni Merlino, Giuseppe Reale, Lucio D’Anna, Domenico Maisano, Alexandros Polymeris, Aurelia Zauli, Leonardo Pantoni, Baptiste Alvarez, Marina Mannino, Hrvoje Budincevic, Ludovica Migliaccio, Giovanni Frisullo, Laura Tudisco, Emanuele Spina, Marialuisa Zedde, Piergiorgio Lochner
article en
1 citations

Abstract

BACKGROUND: Sex-specific outcomes after breakthrough ischemic stroke on oral anticoagulation (OAC) are unexplored. We compared 90-day outcomes by sex and explored modifiers. METHODS: ASPERA-R (Advancing Knowledge in Ischemic Stroke Patients on Oral Anticoagulants retrospective cohort; NCT06823466) was an international, multicenter, retrospective study enrolling adults (aged >18 years) with breakthrough ischemic stroke on OAC for atrial fibrillation. Primary outcome was 90-day return to baseline neurologic function (modified Rankin Scale [mRS] score 0-1 maintained if prestroke 0-1; or same/lower mRS score if prestroke ≥2). Secondary outcomes were 90-day mRS shift, recurrent ischemic stroke/transient ischemic attack, myocardial infarction, and all-cause and vascular death. Safety outcomes included 90-day moderate-to-severe bleeding, intracranial hemorrhage, 24-hour hemorrhagic transformation, and 24-hour symptomatic intracranial hemorrhage. We applied inverse probability weighting and regression models to compare outcomes. Prespecified subgroup analysis tested sex-specific interactions. RESULTS: =0.070). Subgroup analyses revealed significant sex interactions for OAC type, competing cause, endovascular treatment, and OAC restart. CONCLUSIONS: Women had worse 90-day outcomes than men after breakthrough ischemic stroke on OAC for atrial fibrillation, highlighting the need for sex-aware management.

Journal of the American Heart AssociationVol. 15(7)
Università Cattolica del Sacro Cuore (IT), Ain Shams University (EG), Marche Polytechnic University (IT), University of Udine (IT), North Bristol NHS Trust (GB), St. George's University (GD), Harvard University (US), University of Lisbon (PT), University of Trieste (IT), Cairo University (EG), Imperial College Healthcare NHS Trust (GB), University of Basel (CH), University of Milan (IT), University of Pavia (IT), University of L'Aquila (IT), Hospital Universitario La Paz (ES), King Fahd Medical City (SA), Agostino Gemelli University Polyclinic (IT), University Medical Center (US), Klinička bolnica "Sveti Duh" (HR), Ospedale Maggiore (IT), Ospedale Antonio Cardarelli (IT), Luigi Sacco Hospital (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Unidade Local de Saúde de São José (PT), Hospital de São José (PT), Ospedale Vincenzo Cervello (IT), Hospital La Paz Institute for Health Research (ES), Urology Foundation (GB), Casa di Cura Columbus (IT), Azienda USL di Bologna (IT), Istituto delle Scienze Neurologiche di Bologna (IT), Observatoire de la Côte d’Azur (FR), Società Italiana di Reumatologia (IT), Onkologikoa (ES), Azienda Ospedaliera Ospedale Maggiore (IT), Hospital de Santa Maria (PT), University of the Sacred Heart (JP), Ospedale Vito Fazzi (IT), Ospedale Civile di Venezia (IT), Imperial College London (GB), University of Osijek (HR), Universidad Autónoma de Madrid (ES), Misericordia University (US), Martin Luther University Halle-Wittenberg (DE), Assiut University (EG), Saarland University (DE), University of Minho (PT)
Openalex Percentile: Top 1%
Atrial Fibrillation Management and Outcomes
18.76
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