Abstract Number: Esoc2026a35 Impact of Cancer on Outcomes Following Breakthrough Ischemic Stroke on Oral Anticoagulants for Atrial Fibrillation: Insights From the Aspera-r Study
Year: 2026
Type: conference-abstract
Abstract: Background and aims Breakthrough ischemic stroke during oral anticoagulation (OAC) for atrial fibrillation (AF) represents a major therapeutic challenge, especially in patients with cancer, who face competing risks of thrombosis and bleeding. This study investigated the impact of cancer on 90-day outcomes after ischemic stroke on OAC. Methods We analyzed patients with AF who experienced ischemic stroke while on continuous OAC enrolled in the international retrospective ASPERA-R study, comprising 35 stroke centers across 9 countries. Inverse probability weighting (IPW) was applied to adjust for baseline imbalances, and weighted Cox, ordinal logistic and generalized liner models were used to estimate adjusted 90-day risks for the primary (ischemic stroke or TIA), secondary (mRS shift, vascular/all-cause death), and safety (moderate-to-severe bleeding, intracranial hemorrhage, 24-h hemorrhagic transformation) outcomes. Results Among 1,649 included patients (mean age 78.0 ± 10.7 years; 45.8% male), 247 (15.0%) had cancer, of whom 87 (35.2%) active and 160 (64.8%) in remission. After IPW, patients with cancer had a higher 90-day risk of new ischemic stroke or TIA (8.2% vs 2.8%; aHR 2.56,95% CI 1.59–4.13;P < 0.001) and worse mRS score (aOR 1.29,95% CI 1.08-1.54;P = 0.005) than those without cancer. Active cancer conferred a > 4-fold higher risk of new ischemic stroke/TIA and nearly 3-fold of moderate-to-severe bleeding. Hematological malignancies carried higher risk for both new ischemic stroke/TIA and moderate-to-severe bleeding versus solid malignancies. Conclusion Cancer, particularly active and hematological malignancies, substantially worsens 90-day prognosis after breakthrough stroke on OAC for AF. Conflict of interest Prof Casolla declares speaker’s fees from ACTICOR Biotech and SANOFI-AVENTIS France. 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. Figure 1 - belongs to Results
Source: European Stroke Journal
Institutions: University of L'Aquila, Ospedale "Santa Maria delle Croci" di Ravenna, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Imperial College London, Ospedale Maggiore Carlo Alberto Pizzardi, Istituto delle Scienze Neurologiche di Bologna, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Université Côte d'Azur, Hôpital Pasteur, University of Udine, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research, Universidad Autónoma de Madrid, St George's Hospital, St George's, University of London, University of Lisbon, Unidade Local de Saúde de São José, Hospital de São José
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
OpenAlex ID: W7160443172
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