Atrial fibrillation is the most common type of abnormal heart rhythm and is associated with a higher risk of stroke.
The researchers found patients often had another underlying reason for the stroke, such as interactions with other medicines or causes unrelated to their heart rhythm condition. These patients were also at higher risk of having another stroke or a heart attack in the weeks and months afterwards.
These findings are from ASPERA, an international programme to improve acute stroke treatment and care, involving hospitals around the world. ASPERA aims to improve understanding of ischaemic stroke in people who are taking blood-thinning medicines, particularly those prescribed for atrial fibrillation and other heart rhythm conditions. Ischaemic strokes happen when a blocked or narrowed blood vessel cuts off blood flow to part of the brain, causing brain cells to die from a lack of oxygen.
ASPERA-R, a study within the programme, investigates "breakthrough" ischaemic strokes caused by atrial fibrillation. Breakthrough strokes occur despite a patient continuously taking oral blood thinners (anticoagulants).
Led by the University of L'Aquila in Italy, ASPERA uses healthcare records from 35 stroke centres in 15 countries across Europe and the Middle East, including BFT’s Southmead Hospital.
The ASPERA team have uncovered a range of other findings, including:
- That having cancer negatively affects recovery and risk of complications
- Whether outcomes differ between men and women
- The influence of where the stroke occurred in the brain
- The effects of additional stroke mechanisms other than atrial fibrillation
- Whether switching blood thinning medication after a breakthrough ischaemic stroke improves outcomes
Sandeep Buddha, Consultant Stroke Physician and Stroke Research Delivery Lead at Southmead Hospital, said:
"ASPERA is helping to answer some of the most important unanswered questions in stroke medicine. By studying patients who experience an ischaemic stroke while taking blood-thinning medication, we can build a clearer picture of the factors involved and develop more personalised treatment strategies.
“I'm pleased that our stroke unit is playing a role in this international effort to improve outcomes for stroke patients."
Papers
Decoding the causes of ischemic stroke despite ongoing oral anticoagulation and their clinical impact: the ASPERA-R study
Federico de Santis et al, Journal of Neurology
Impact of cancer on outcomes following breakthrough ischaemic stroke on oral anticoagulants for atrial fibrillation: insights from the ASPERA-R study
Matteo Foschi et al, European Stroke Journal
Competing Stroke Etiologies and Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants in Patients with Atrial Fibrillation
Matteo Foschi et al, Neurology
Continuation vs Switching Direct Oral Anticoagulant Therapy After Breakthrough Stroke
Lucio D’Anna et al, JAMA Network Open
Early versus Late starting of Direct Oral Anticoagulants after breakthrough ischemic stroke: A Target Trial Analysis from the ASPERA-R Study
Lucio D’Anna et al, International Journal of Stroke
Sex Differences in Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants for Atrial Fibrillation: An ASPERA-R Inverse Probability Weighted Analysis
Matteo Foschi et al, Journal of the American Heart Association
Posterior versus anterior circulation infarct location and outcomes after breakthrough ischemic stroke in orally anticoagulated patients for atrial fibrillation: An ASPERA-R inverse probability–weighted analysis
Matteo Foschi et al, Journal of the Neurological Sciences