Evidence map›Paper›PMID 41758563›Full record

Observational studyEuropean stroke journal2026

Impact of cancer on outcomes following breakthrough ischaemic stroke on oral anticoagulants for atrial fibrillation: insights from the ASPERA-R study.

Matteo Foschi, Federico De Santis, Francesca Gabriele, Lucio D'Anna, Andrea Zini, Matteo Paolucci, Stefano Forlivesi, Ludovica Migliaccio, Maria Maddalena Viola, Angelo Cascio Rizzo and 89 more

Registry-linked trialAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06823466 (Advancing Knowledge in Ischemic Stroke Patients on Oral Anticoagulants - The ASPERA International Registry), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06823466 recruitingnot on this map

Advancing Knowledge in Ischemic Stroke Patients on Oral Anticoagulants - The ASPERA International Registry

Typeobservational_patient_registrySponsorUniversity of L'AquilaRan2025 to 2031Enrolled200ConditionsIschemic Stroke, Oral Anticoagulation, Atrial Fibrillation (AF), Outcome Assessment
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

99 authors.

Matteo FoschiDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.ORCID 0000-0002-0321-7155
Federico De SantisDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.ORCID 0000-0002-8059-6427
Francesca GabrieleDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.ORCID 0009-0006-0393-2956
Lucio D'AnnaDepartment of Stroke and Neuroscience, Charing Cross Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom.ORCID 0000-0002-6794-3850
Andrea ZiniDepartment of Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.ORCID 0000-0003-1486-4507
Matteo PaolucciDepartment of Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.ORCID 0000-0002-5347-378X
Stefano ForlivesiDepartment of Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.ORCID 0000-0003-0609-3044
Ludovica MigliaccioDepartment of Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Maria Maddalena ViolaDepartment of Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Angelo Cascio RizzoDepartment of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.ORCID 0000-0002-3258-5061
Maria SessaDepartment of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Ghil SchwarzDepartment of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Rachele TortorellaDepartment of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Soma BanerjeeDepartment of Stroke and Neuroscience, Charing Cross Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom.
Gaurav DesaiDepartment of Stroke and Neuroscience, Charing Cross Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom.
Muhammad JaffarDepartment of Stroke and Neuroscience, Charing Cross Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom.
Gabriele PrandinClinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy.
Leonardo PantoniNeuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.ORCID 0000-0001-7357-8530
Francesco MeleNeurology Unit, University Hospital Luigi Sacco, Milan, Italy.
Giuseppe ScopellitiNeurology Unit, University Hospital Luigi Sacco, Milan, Italy.
Ilaria CovaNeurology Unit, University Hospital Luigi Sacco, Milan, Italy.
Mariarosaria ValenteClinical Neurology, DMED, University of Udine, Udine, Italy.
Domenico MaisanoClinical Neurology, DMED, University of Udine, Udine, Italy.
Luca AntonelliClinical Neurology, DMED, University of Udine, Udine, Italy.
Maria Rosaria BagnatoUOC Stroke Unit e Neurologia, Ospedale Fabrizio Spaziani, Frosinone, Italy.
Giovanni Di MauroUOC Stroke Unit e Neurologia, Ospedale Fabrizio Spaziani, Frosinone, Italy.
Francesca BernocchiUOC Stroke Unit e Neurologia, Ospedale Fabrizio Spaziani, Frosinone, Italy.
Martina Gaia Di DonnaUOC Stroke Unit e Neurologia, Ospedale Fabrizio Spaziani, Frosinone, Italy.
Barbara CasollaStroke Unit, CHU Pasteur 2, Université Cote d'Azur, UMR2CA, Nice, France.ORCID 0000-0002-1047-6371
Myriam Perla MazloumStroke Unit, CHU Pasteur 2, Université Cote d'Azur, UMR2CA, Nice, France.
Kristina KacaniStroke Unit, CHU Pasteur 2, Université Cote d'Azur, UMR2CA, Nice, France.
Noufel-Anis DjeghlalStroke Unit, CHU Pasteur 2, Université Cote d'Azur, UMR2CA, Nice, France.
Laura González-MartínStroke Center and Department of Neurology, Hospital La Paz Institute for Health Research-ldlPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain.ORCID 0000-0001-9840-8126
Ricardo RigualStroke Center and Department of Neurology, Hospital La Paz Institute for Health Research-ldlPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain.
Blanca FuentesStroke Center and Department of Neurology, Hospital La Paz Institute for Health Research-ldlPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain.ORCID 0000-0002-8716-6344
Carlos HervásStroke Center and Department of Neurology, Hospital La Paz Institute for Health Research-ldlPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain.
Paolo CandelaresiUOC Neurologia e Stroke Unit, AORN Cardarelli, Napoli, Italy.
Vincenzo AndreoneUOC Neurologia e Stroke Unit, AORN Cardarelli, Napoli, Italy.
Antonio De MaseUOC Neurologia e Stroke Unit, AORN Cardarelli, Napoli, Italy.
Emanuele SpinaUOC Neurologia e Stroke Unit, AORN Cardarelli, Napoli, Italy.
Diana Aguiar de SousaStroke Center, Department of Neurosciences, Centro Hospitalar Universitário Lisboa Central, ULS São José, and Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.ORCID 0000-0002-6702-7924
Mariana Almudi SouzaStroke Center, Department of Neurosciences, Centro Hospitalar Universitário Lisboa Central, ULS São José, Lisbon, Portugal.
Alberto FiorStroke Center, Department of Neurosciences, Centro Hospitalar Universitário Lisboa Central, ULS São José, Lisbon, Portugal.
Miguel SerôdioStroke Center, Department of Neurosciences, Centro Hospitalar Universitário Lisboa Central, ULS São José, Lisbon, Portugal.
Pietro CaliandroDepartment of Neuroscience, Catholic University of the Sacred Hearth, Rome, Italy.ORCID 0000-0002-1190-4879
Aurelia ZauliDepartment of Neuroscience, Catholic University of the Sacred Hearth, Rome, Italy.
Giuseppe RealeUOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Ahmed AbdelalimCairo University Stroke Center, Department of Neurology, Faculty of Medicine, Cairo University, Giza, Egypt.
Sandra AhmedCairo University Stroke Center, Department of Neurology, Faculty of Medicine, Cairo University, Giza, Egypt.
Nourhan Mohamed SolimanCairo University Stroke Center, Department of Neurology, Faculty of Medicine, Cairo University, Giza, Egypt.ORCID 0000-0003-4394-942X
Liqun ZhangDepartment of Neurology, St George's University Hospital, London, United Kingdom.
Tara LatimerDepartment of Neurology, St George's University Hospital, London, United Kingdom.
Muhammad ElboghdayDepartment of Neurology, St George's University Hospital, London, United Kingdom.
Ahmed Aly ElbassiounyNeurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Tamer RoushdyNeurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Hossam ShokriNeurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Federica FerrariDepartment of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Nicola Davide LoizzoDepartment of Emergency Neurology and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy.
Federico MazzacaneDepartment of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Maria GuarinoIRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.ORCID 0000-0002-8894-2187
Valentina BaroneIRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.ORCID 0000-0002-7520-5874
Paola FortiDepartment of Medical and Surgical Sciences, University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Giuseppe RinaldiS.C. Neurologia, Ospedale "Di Venere", Bari, Italy.
Marco Vito RossiDepartment of Neurosciences, Stroke Unit-Neurology Unit, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy.
Vincenzo LaterzaS.C. Neurologia, Ospedale "Di Venere", Bari, Italy.
Giovanni FrisulloEmergency Neurology Unit, Department of Neuroscience, Sensory Organs, and Thorax, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Pier Andrea RizzoCatholic University of the Sacred Heart, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy.
Aldobrando BroccoliniStroke Unit, Department of Neuroscience, Sensory Organs, and Thorax, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Marina ManninoUOC Neurologia e Stroke Unit, AOOR Villa Sofia-Cervello, Palermo, Italy.ORCID 0000-0001-7683-7235
Valeria TerrusoUOC Neurologia e Stroke Unit, AOOR Villa Sofia-Cervello, Palermo, Italy.
Marcella CaggiulaUOC Neurologia e Stroke Unit, PO Vito Fazzi, Lecce, Italy.
Annalisa RizzoUOC Neurologia e Stroke Unit, PO Vito Fazzi, Lecce, Italy.
Ana Catarina FonsecaNeurology Department, Hospital de Santa Maria, Faculdade de Medicina, University of Lisbon, Lisbon, Portugal.ORCID 0000-0002-6752-5123
Bernardo AntunesDepartment of Neurology, Hospital de Santa Maria, Lisbon, Portugal.ORCID 0000-0002-5514-7481
Ana M BarbosaDepartment of Neurology, Hospital de Santa Maria, Lisbon, Portugal.ORCID 0000-0003-0128-9214
Hrvoje BudincevicDepartment of Neurology, Sveti Duh University Hospital, Zagreb, Croatia.ORCID 0000-0002-0184-8949
Petra CrnacDepartment of Neurology, Sveti Duh University Hospital, Zagreb, Croatia.ORCID 0000-0003-4821-9964
Giovanna ViticchiNeurological Clinic, Marche Polytechnic University, Ancona, Italy.ORCID 0000-0003-1045-0896
Mauro SilvestriniNeurological Clinic, Marche Polytechnic University, Ancona, Italy.ORCID 0000-0002-3862-3207
Lorenzo BarbaDepartment of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.ORCID 0000-0003-1328-3620
Markus OttoDepartment of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.ORCID 0000-0001-7422-1863
Piergiorgio LochnerDepartment of Neurology, Saarland University Medical Center, Homburg 66421, Germany.ORCID 0000-0002-1467-7653
Benjamin LandauDepartment of Neurology, Saarland University Medical Center, Homburg 66421, Germany.ORCID 0000-0002-5103-7096
Sandeep BuddhaDepartment of Stroke Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
Roumeisa KhalilDepartment of Stroke Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
Maria Grazia PiscagliaDepartment of Neurosciences, Stroke Unit-Neurology Unit, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy.
Elena MinguzziDepartment of Neurosciences, Stroke Unit-Neurology Unit, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy.
Marialuisa ZeddeNeurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.ORCID 0000-0001-7530-818X
Ahmed NasreldeinDepartment of Neurology, Assiut University, Assiut, Egypt.
Luisa VinciguerraDepartment of Neurology and Stroke Unit, ASST Crema Hospital, Crema, Italy.
Luis CostaDepartment of Neurology, Local Health Unit of Alto Minho, Viana do Castelo, Portugal.
Ahmed Elsaid ElsayedNeurology and Neurointervention Department, Kobry Elkoba Medical Complex, Cairo, Egypt.
Mona AlBannaDepartment of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
Laura TudiscoStroke Unit, Careggi University Hospital, Florence, Italy.
Maria Giulia MosconiDepartment of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, Perugia, Italy.ORCID 0000-0002-0456-9160
Giovanni MerlinoSOSD Stroke Unit, Udine University Hospital, Udine, Italy.ORCID 0000-0002-6525-9529
Alexandros PolymerisStroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.ORCID 0000-0002-9475-2208
Raffaele OrnelloDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.ORCID 0000-0001-9501-4031
Simona SaccoDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.ORCID 0000-0003-0651-1939

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBreakthrough ischaemic 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 ischaemic stroke on OAC. PATIENTS AND

methodsWe analysed patients with AF who experienced ischaemic stroke while on continuous OAC enrolled in the international retrospective ASPERA-R study, comprising 35 stroke centres across 9 countries. Inverse probability weighting was applied to adjust for baseline imbalances, and weighted Cox, ordinal logistic and generalised linear models were used to estimate adjusted 90-day risks for the primary (ischaemic stroke or TIA), secondary (mRS shift, vascular/all-cause death) and safety (moderate-to-severe bleeding, ICH, 24-h haemorrhagic transformation) outcomes.

resultsAmong 1649 included patients (mean age 78.0 ± 10.7 years; 45.8% male), 247 (15.0%) had cancer, of whom 87 (35.2%) had active cancer and 160 (64.8%) were in remission. After weighting, patients with cancer had a significantly higher 90-day risk of new ischaemic stroke or TIA (8.2% vs 2.8%; adjusted hazard ratio [aHR] 2.56; 95% CI, 1.59-4.13; P < .001) and worse 90-day mRS score distribution (adjusted odds ratio 1.29; 95% CI, 1.08-1.54; P = .005) than those without cancer. Active cancer conferred a > 4-fold higher risk of new ischaemic stroke or TIA (HR 4.48, 95% CI, 2.46-8.13; P < .001) and nearly 3-fold higher risk of moderate-to-severe bleeding (HR 2.77; 95% CI, 1.30-5.88; P = .008). Patients with cancer in remission showed increased ischaemic risk (HR 2.60; 95% CI, 1.59-5.25; P = .001) but not bleeding risk. Haematological malignancies carried a higher risk for both new ischaemic stroke or TIA (HR 3.06; 95% CI, 1.69-5.54; P = .001) and moderate-to-severe bleeding (HR 3.47, 95% CI, 1.57-7.70; P = .006) compared to solid malignancies.

conclusionCancer, particularly active and haematological malignancies, substantially worsens 90-day prognosis after breakthrough stroke on OAC, underscoring the need for refined risk stratification and tailored secondary prevention.

trial registrationURL: www.clinicaltrials.gov; Unique identifier: NCT06823466.

Indexed as

AnticoagulantsAtrial FibrillationIschemic StrokeNeoplasmsStrokeAdministration, OralAgedAged, 80 and overFemaleHemorrhageHumansMaleRetrospective StudiesTreatment OutcomeAnticoagulantsatrial fibrillationcancerischaemic strokemalignancyoral anticoagulationoutcomesprognosis

Identifiers

PMID41758563
PMCPMC12947708

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Registered trials

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