ABSTRACT NUMBER: ESOC2026A7 SEX DIFFERENCES IN OUTCOMES AFTER BREAKTHROUGH ISCHEMIC STROKE ON ORAL ANTICOAGULANTS FOR ATRIAL FIBRILLATION: AN ASPERA-R INVERSE PROBABILITY WEIGHTED ANALYSIS

Abstract Background and aims Patients with breakthrough ischemic stroke on oral anticoagulation (OAC) for atrial fibrillation (AF) face high risks of recurrence and bleeding, but sex-specific outcomes are unexplored. We compared 90-day outcomes by sex. Methods ASPERA-R was an internationalretrospective study enrolling adults (>18 years) with breakthrough ischemic stroke on OAC for AF, across 35 centers in 9 countries. Primary outcome was 90-day return to baseline neurological function (mRS 0–1 if pre-stroke 0–1; same/lower mRS if pre-stroke ≥2). Secondary outcome were 90-day mRS shift, recurrent ischemic stroke/TIA, myocardial infarction, all-cause/vascular death. Safety outcomes included 90-day moderate-to-severe bleeding, intracranial hemorrhage (ICH), 24-h hemorrhagic transformation (HT) and symptomatic ICH. We applied inverse probability weighting and weighted generalized linear, ordinal and Cox models. Prespecified subgroup analysis tested p-for-interaction. Results We included 1649 patients (women 52.2%; mean age 78.0 ± 10.7). Women were older, had higher baseline NIHSS and pre-stroke mRS. In the weighted cohort, women were less likely to return to baseline neurological function (35.2% vs 42.7%; aRD −5.0%[−9.2% to −0.7%];P = 0.021), had worse mRS distribution (aOR 1.17[1.01–1.37];P = 0.043) and higher recurrent ischemic stroke/TIA (4.8% vs 2.8%; aHR 1.70[1.01–2.86];P = 0.045) at 90 days. Women showed a trend toward more moderate-to-severe bleeding (4.6% vs 2.8%; aHR 1.63[0.96–2.72];P = 0.070). Subgroup analysis showed interactions for OAC type, competing etiology and endovascular treatment. Conclusions Women showed worse 90-day outcomes, highlighting the need for sex-aware management. Ongoing studies, including ASPERA prospective, will provide further insights on sex-specific differences. Conflict of interest Prof Casolla declares speaker’s fees from ACTICOR Biotech and SANOFI-AVENTIS France. Prof Pantoni declares consultancy fees from Medtronic, PIAM and Amicus. Prof Sacco reports compensation from Novartis for other services; compensation from Novo Nordisk for consultant services; compensation from Boehringer Ingelheim for consultant services; compensation from Teva Pharmaceutical Industries for consultant services; compensation from Allergan for consultant services; employment by Università degli Studi dell’Aquila; compensation from Novartis for consultant services; compensation from Allergan for consultant services; compensation from PFIZER CANADA INC for consultant services; compensation from Abbott Canada for consultant services; compensation from H. Lundbeck A S for consultant services; compensation from AstraZeneca for consultant services; and compensation from Eli Lilly and Company for consultant services. Dr Zini declares consulting and speaker fees from Bayer, Boehringer-Ingelheim, Alexion, Daiichi Sankyo, Pfizer, PIAM, Amgen, fees for Advisory Board from Boehringer-Ingelheim, Daiichi Sankyo, Bayer and Astra Zeneca, not related to this study. The other authors have nothing to disclose. Figure 1 - belongs to Results