ABSTRACT NUMBER: ESOC2026A1458 BALANCING BENEFITS AND RISKS: LONG-TERM BLEEDING COMPLICATIONS IN YOUNG ADULTS AFTER ISCHEMIC STROKE OR TIA

Abstract Background and aims Antithrombotic therapy is routinely prescribed to young adults after ischemic stroke to prevent recurrent vascular events. Whether the long-term benefit–risk balance of antithrombotic therapy is favorable in young patients, remains unknown. We investigated the long-term risk of bleeding associated with antithrombotic therapy in young stroke survivors. Methods We included patients aged 18-49 years with a first-ever ischemic stroke from the Observational Dutch Young Symptomatic StrokE studY (ODYSSEY). Bleeding events were identified through standardized follow-up questionnaires, with subsequent verification. Only bleeding events requiring medical evaluation were included. Bleeding severity was classified according to the Bleeding Academic Research Consortium (BARC) criteria. We assessed cumulative incidence, annual bleeding rates and associated risk factors. Results 1,226 patients were included (median age 44 years [38-48]; 52% male), with a median follow-up of 4.22 years [IQR 2.22-5.87]. During follow-up, 129 patients experienced at least one bleeding event, corresponding to a five-year cumulative risk of 10.7%. The annual bleeding rate was 2.52 per 100 person-years. Bleeding events were most frequently gynecologic (55.8%) and gastrointestinal (21.7%). Female sex (HR 3.39; CI 2.29-5.01), cardioembolic etiology (HR 2.17; CI 1.27-3.71), and anticoagulant use (HR 3.07; CI 1.24-7.65) were associated with increased bleeding risk. Conclusions Young stroke survivors face a substantial long-term risk of bleeding while receiving antithrombotic therapy. These findings underscore the need to carefully weigh bleeding risks, as in selected cases, the long-term bleeding risk may exceed the risk of recurrent ischemic events. The ongoing STOP trial will provide further evidence to support individualized risk assessment in young patients with cryptogenic stroke. Conflict of interest Nothing to disclose.