{"id":"4bce34253082","type":"article","url":"https://hartvaat.nl/2026/04/01/doorgaan-met-dezelfde-doac-na-breakthrough-beroerte-even-goed-als-wisselen/","title":"Doorgaan met dezelfde DOAC na breakthrough-beroerte even goed als wisselen","title_en":"","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"JAMA network open","doi":"10.1001/jamanetworkopen.2026.9584","source_url":"https://doi.org/10.1001/jamanetworkopen.2026.9584","authors":["Lucio D'Anna","Francesca Gabriele","Raffaele Ornello","Andrea Zini","Matteo Paolucci","Stefano Forlivesi","Ludovica Migliaccio","Maria Maddalena Viola","Angelo Cascio Rizzo","Maria Sessa","Ghil Schwarz","Rachele Tortorella","Gabriele Prandin","Soma Banerjee","Gurav Desai","Leonardo Pantoni","Francesco Mele","Giuseppe Scopelliti","Ilaria Cova","Mariarosaria Valente","Domenico Maisano","Maria Rosaria Bagnato","Giovanni Di Mauro","Francesca Bernocchi","Martina Gaia Di Donna","Barbara Casolla","Marie-Helene Mahagne","Marie-Eve Amoretti","Lucille Morgan","Laura González","Ricardo Rigual","Blanca Fuentes","Carlos Hervás","Paolo Candelaresi","Vincenzo Andreone","Antonio De Mase","Emanuele Spina","Diana Aguiar de Sousa","Mariana Almudi Souza","Alberto Fior","Miguel Serôdio","Pietro Caliandro","Aurelia Zauli","Giuseppe Reale","Ahmed Abdelalim","Sandra Ahmed","Samah Ali Ismail","Liqun Zhang","Tara Latimer","Muhammad Elboghday","Ahmed El Bassiouny","Tamer Roushdy","Hossam Shokri","Federica Ferrari","Nicola Davide Loizzo","Federico Mazzacane","Maria Guarion","Valentina Barone","Paola Forti","Giuseppe Rinaldi","Marco Rossi","Vincenzo Laterza","Giovanni Frisullo","Pier Andrea Rizzo","Aldobrando Broccolini","Marina Mannino","Valeria Terruso","Marcella Caggiula","Simona Scalise","Ana Catarina Fonseca","Bernardo Antunes","Hrvoje Budincevic","Petra Crnac","Giovanna Viticchi","Mauro Silvestrini","Lorenzo Barba","Viktoria Musienko","Piergiorgio Lochner","Benjamin Landau","Sandeep Buddha","Roumeisa Khalil","Maria Grazia Piscaglia","Elena Minguzzi","Marialuisa Zedde","Ahmed Nasreldein","Luisa Vinciguerra","Luis Costa","Ahmed ElsaidElsayed","Mona Al Banna","Laura Tudisco","Maria Giulia Mosconi","Giovanni Merlino","Federico De Santis","Simona Sacco","Matteo Foschi"],"significance":7,"published":"2026-05-04","source_date":"2026-04-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"A registry-based emulated target trial of 1,006 AF patients with ischaemic stroke during DOAC therapy: 463 continued the same DOAC and 543 switched. After IPTW adjustment, 90-day net clinical benefit was 4.9% with switching versus 5.1% with continuation, a difference of −0.3 percentage points (90% CI −2.7 to 2.1) — within the prespecified non-inferiority margin. Recurrent ischaemic events, intracerebral haemorrhage, all-cause mortality and vascular death did not differ. After a breakthrough stroke on DOAC, switching is not better than continuing — the upfront DOAC choice matters more.","created":"2026-07-03T10:32:50Z","updated":"2026-07-03T13:31:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicentre register-emulated trial van 1006 AF-patiënten die een ischemische beroerte kregen tijdens DOAC-therapie: 463 continueerden dezelfde DOAC, 543 wisselden. Na inverse probability weighting was de 90-daagse netto klinische baat 4,9% bij wisselen en 5,1% bij continueren — een verschil van -0,3%-punt (90% BI -2,7 tot 2,1), binnen de vooraf bepaalde non-inferioriteitsmarge. Recidief ischemisch event, intracerebrale bloeding, mortaliteit en vasculair overlijden verschilden niet significant. Bij een breakthrough-stroke onder DOAC is wisselen niet beter dan voortzetten — de DOAC-keuze vooraf weegt zwaarder.","abstract_original":"IMPORTANCE: Management after an ischemic stroke occurring despite direct oral anticoagulant (DOAC) therapy for atrial fibrillation (AF) varies widely. Switching anticoagulation is common in clinical practice, although evidence supporting this strategy is limited. OBJECTIVE: To evaluate whether continuation of treatment with the same DOAC was noninferior to switching oral anticoagulant therapy with respect to 90-day clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: This multicenter registry-based cohort study with an emulated target trial design included consecutive adult patients with AF who experienced a breakthrough ischemic stroke while receiving uninterrupted DOAC therapy and resumed anticoagulation therapy thereafter. Patients were enrolled between February 2020 and February 2025, across 35 stroke centers in 9 countries in Europe and North Africa, with a standardized 90-day follow-up. The dataset was locked on September 1, 2025. A noninferiority comparison of switching vs continuation strategies was performed. Baseline confounding was addressed using inverse probability of treatment weighting (IPTW). The primary noninferiority margin was an absolute risk difference of 3.0 percentage points in 90-day net clinical benefit. EXPOSURE: The intervention group switched to treatment with a different DOAC or vitamin K antagonist; the comparator group continued therapy with the prestroke DOAC. MAIN OUTCOMES AND MEASURES: The primary outcome was 90-day net clinical benefit, defined as recurrent ischemic stroke and moderate to severe bleeding. Secondary outcomes included recurrent ischemic events, symptomatic intracerebral hemorrhage, moderate to severe extracranial bleeding, all-cause mortality, and vascular death. RESULTS: Among 1006 patients included in the analysis (median age, 80.4 [IQR, 73.4-85.4] years; 503 female [50.0%] and 503 [50.0%] male), 463 (46.0%) continued the same DOAC therapy and 543 (54.0%) switched therapy. After IPTW adjustment, the 90-day net clinical benefit was 4.9% with switching and 5.1% with continuation, corresponding to a risk difference of -0.3 percentage points (90% CI, -2.7 to 2.1 percentage points), meeting the prespecified noninferiority criterion. For recurrent ischemic events and bleeding outcomes, the absolute differences were within the predefined noninferiority margins. Noninferiority was not demonstrated for all-cause or vascular mortality. CONCLUSIONS AND RELEVANCE: In patients with breakthrough ischemic stroke during DOAC therapy, switching anticoagulation treatment was not associated with clinically meaningful short-term benefit compared with continuation. These findings suggest that switching does not provide additional benefit compared with continuing treatment with the same DOAC. Randomized clinical trials are needed to identify strategies to improve secondary prevention after a breakthrough ischemic stroke."}