{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:03:44Z","timestamp":1789715024014,"version":"4.0.1"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,4,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Sex\u2010specific outcomes after breakthrough ischemic stroke on oral anticoagulation (OAC) are unexplored. We compared 90\u2010day outcomes by sex and explored modifiers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">ASPERA\u2010R (Advancing Knowledge in Ischemic Stroke Patients on Oral Anticoagulants retrospective cohort; NCT06823466) was an international, multicenter, retrospective study enrolling adults (aged &gt;18\u2009years) with breakthrough ischemic stroke on OAC for atrial fibrillation. Primary outcome was 90\u2010day return to baseline neurologic function (modified Rankin Scale [mRS] score 0\u20131 maintained if prestroke 0\u20131; or same\/lower mRS score if prestroke \u22652). Secondary outcomes were 90\u2010day mRS shift, recurrent ischemic stroke\/transient ischemic attack, myocardial infarction, and all\u2010cause and vascular death. Safety outcomes included 90\u2010day moderate\u2010to\u2010severe bleeding, intracranial hemorrhage, 24\u2010hour hemorrhagic transformation, and 24\u2010hour symptomatic intracranial hemorrhage. We applied inverse probability weighting and regression models to compare outcomes. Prespecified subgroup analysis tested sex\u2010specific interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We included 1649 patients (women, 52.2%; mean\u00b1SD age, 78.0\u00b110.7\u2009years). Women were older (80.2\u00b19.6 versus 76.3\u00b110.8\u2009years; unweighted standardized mean difference=0.376), had higher baseline National Institutes of Health Stroke Scale score (13 [interquartile range, 9\u201319] versus 9 [interquartile range, 4\u201317]; unweighted standardized mean difference=0.227), and worse prestroke mRS score (unweighted standardized mean difference=0.237). After weighting, women were less likely to return to baseline neurologic function (35.2% versus 42.7%; adjusted risk ratio, 0.82 [95% CI, 0.71\u20130.96];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.015), had worse mRS distribution (adjusted odds ratio, 1.17 [95% CI, 1.01\u20131.37];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.043), and had higher recurrent ischemic stroke\/transient ischemic attack (4.8% versus 2.8%; adjusted hazard ratio [HR], 1.70 [95% CI, 1.01\u20132.86];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.045). Women showed a trend toward more moderate\u2010to\u2010severe bleeding (4.6% versus 2.8%; adjusted HR, 1.63 [95% CI, 0.96\u20132.72];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.070). Subgroup analyses revealed significant sex interactions for OAC type, competing cause, endovascular treatment, and OAC restart.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Women had worse 90\u2010day outcomes than men after breakthrough ischemic stroke on OAC for atrial fibrillation, highlighting the need for sex\u2010aware management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047064","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T10:08:11Z","timestamp":1774951691000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Sex Differences in Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants for Atrial Fibrillation: An ASPERA\u2010R Inverse Probability Weighted Analysis"],"prefix":"10.1161","volume":"15","author":[{"given":"Matteo","family":"Foschi","sequence":"first","affiliation":[{"name":"University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]},{"name":"AUSL Romagna","place":["Ravenna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucio","family":"D\u2019Anna","sequence":"additional","affiliation":[{"name":"Imperial College London NHS Healthcare Trust","place":["London, UK"]},{"name":"Imperial College London","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Gabriele","sequence":"additional","affiliation":[{"name":"University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Ornello","sequence":"additional","affiliation":[{"name":"University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Zini","sequence":"additional","affiliation":[{"name":"Maggiore Hospital","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Paolucci","sequence":"additional","affiliation":[{"name":"Maggiore Hospital","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Forlivesi","sequence":"additional","affiliation":[{"name":"Maggiore Hospital","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Migliaccio","sequence":"additional","affiliation":[{"name":"Maggiore Hospital","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Maddalena","family":"Viola","sequence":"additional","affiliation":[{"name":"Maggiore Hospital","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Cascio Rizzo","sequence":"additional","affiliation":[{"name":"ASST Grande Ospedale Metropolitano Niguarda","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Sessa","sequence":"additional","affiliation":[{"name":"ASST Grande Ospedale Metropolitano Niguarda","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghil","family":"Schwarz","sequence":"additional","affiliation":[{"name":"ASST Grande Ospedale Metropolitano Niguarda","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachele","family":"Tortorella","sequence":"additional","affiliation":[{"name":"ASST Grande Ospedale Metropolitano Niguarda","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soma","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Imperial 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