Key result
Antithrombotic therapy in young stroke survivors is linked to an ~11% five-year risk of medically evaluated bleeding.
Why the study?
Whether the long-term benefit-risk balance of antithrombotic therapy is favorable in young patients after ischemic stroke remains unknown.
What is the long-term risk of bleeding associated with antithrombotic therapy in young adults after ischemic stroke?
Observational (n=1,226)
What is the long-term risk of bleeding associated with antithrombotic therapy in young adults after ischemic stroke?
Young stroke survivors on antithrombotic therapy face a substantial long-term bleeding risk (10.7% at 5 years), highlighting the need for individualized risk-benefit assessment.
Warrants caution with long-term antithrombotic therapy in young stroke survivors; leaves open net clinical benefit and requires randomized trials.
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.
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Rasing et al. (2026) conducted an observational in Ischemic stroke (n=1,226). Antithrombotic therapy was evaluated on Bleeding events requiring medical evaluation. Antithrombotic therapy in young stroke survivors was associated with a 10.7% five-year cumulative risk of bleeding requiring medical evaluation (annual rate 2.52 per 100 person-years).
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