Cancer in patients with breakthrough stroke on oral anticoagulation increased the 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).
Cohort (n=1,649)
Yes
Does the presence of cancer worsen 90-day outcomes in patients with AF experiencing breakthrough ischemic stroke on OAC?
In patients with AF and breakthrough stroke on OAC, comorbid cancer (especially active and hematological) substantially increases the 90-day risk of recurrent ischemic events and bleeding.
Effect estimate: aHR 2.56 (95% CI 1.59-4.13)
Absolute Event Rate: 8.2% vs 2.8%
p-value: p=< 0.001
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
Foschi et al. (2026) conducted a cohort in Atrial fibrillation with breakthrough ischemic stroke on oral anticoagulants (n=1,649). Cancer vs. No cancer was evaluated on Ischemic stroke or TIA (aHR 2.56, 95% CI 1.59-4.13, p=< 0.001). Cancer in patients with breakthrough stroke on oral anticoagulation increased the 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).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: