{"id":"f0cd8f93ab87","type":"article","url":"https://hartvaat.nl/2026/10/15/posteriorcirculatie-infarcten-na-doorbraakstroke-op-anticoagulantia-duiden-op-sl/","title":"Posteriorcirculatie-infarcten na doorbraakstroke op anticoagulantia duiden op slechtere prognose","title_en":"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.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the neurological sciences","doi":"10.1016/j.jns.2026.126100","source_url":"https://doi.org/10.1016/j.jns.2026.126100","authors":["Matteo Foschi","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","Muhammad Jaffar","Gabriele Prandin","Leonardo Pantoni","Francesco Mele","Giuseppe Scopelliti","Ilaria Cova","Mariarosaria Valente","Domenico Maisano","Luca Antonelli","Maria Rosaria Bagnato","Giovanni Di Mauro","Francesca Bernocchi","Martina Gaia Di Donna","Barbara Casolla","Antonio Ciacciarelli","Chiara Bruno","Baptiste Alvarez","Laura González-Martín","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","Nourhan Mohamed Soliman","Liqun Zhang","Tara Latimer","Muhammad Elboghday","Ahmed Aly Elbassiouny","Tamer Roushdy","Hossam Shokri","Federica Ferrari","Nicola Davide Loizzo","Federico Mazzacane","Maria Guarino","Valentina Barone","Paola Forti","Giuseppe Rinaldi","Marco Vito Rossi","Vincenzo Laterza","Giovanni Frisullo","Pier Andrea Rizzo","Aldobrando Broccolini","Marina Mannino","Valeria Terruso","Marcella Caggiula","Annalisa Rizzo","Ana Catarina Fonseca","Bernardo Antunes","Ana M Barbosa","Hrvoje Budincevic","Petra Crnac","Giovanna Viticchi","Mauro Silvestrini","Lorenzo Barba","Viktoria Musienko","Markus Otto","Piergiorgio Lochner","Benjamin Landau","Sandeep Buddha","Roumeisa Khalil","Ludovica Maria Miserocchi","Giorgia Balducci","Maria Grazia Piscaglia","Elena Minguzzi","Marialuisa Zedde","Ahmed Nasreldein","Luisa Vinciguerra","Luis Costa","Ahmed Elsaid Elsayed","Mona AlBanna","Laura Tudisco","Giovanni Merlino","Alexandros Polymeris","Federico De Santis","Simona Sacco"],"significance":5,"published":"2026-08-18","source_date":"2026-10-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"A retrospective multicentre analysis of 1,649 atrial fibrillation patients experiencing an ischemic stroke despite continuous oral anticoagulation demonstrates that infarct location significantly influences prognosis. Patients with posterior circulation infarcts faced a higher risk of a 90-day composite endpoint (recurrent stroke, MI, or vascular death; aHR 1.50), greater all-cause mortality (aHR 1.85), and worse functional outcomes (mRS shift) compared to those with anterior circulation infarcts. These findings highlight infarct location as a valuable prognostic marker, aiding risk stratification and follow-up intensity for AF patients experiencing breakthrough strokes on anticoagulation.","created":"2026-08-11T01:11:17Z","updated":"2026-08-11T01:11:17Z","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":"Een retrospectieve multicenteranalyse van 1649 AF-patiënten met een ischemische stroke ondanks continue orale anticoagulatie toont aan dat infarctlocatie de prognose beïnvloedt. Patiënten met een infarct in de posteriorcirculatie hadden een significant hoger risico op een 90-daags composite van recidiefstroke, MI of vasculair overlijden (aHR 1,50), hogere sterfte (aHR 1,85) en een slechtere functionele uitkomst (mRS) vergeleken met anteriorcirculatie-infarcten. Deze bevindingen ondersteunen het gebruik van infarctlocatie als prognostische marker om risicopatiënten na een doorbraakstroke op anticoagulantia te identificeren.","abstract_original":"INTRODUCTION AND AIMS: Breakthrough ischemic stroke may occur despite ongoing oral anticoagulation (OAC) in patients with atrial fibrillation (AF). Whether infarct location influences prognosis remains unclear. We aimed to compare clinical characteristics and outcomes of posterior versus anterior circulation infarct (PCI vs ACI). METHODS: Multicentre retrospective analysis from the ASPERA cohort, including patients with AF and ischemic stroke despite continuous OAC (Feb. 2020 to Feb. 2025). Patients were classified as PCI or ACI according to infarct location. The primary outcome was a 90-day composite of recurrent ischemic stroke, myocardial infarction, or vascular death. Secondary outcomes included modified Rankin Scale (mRS) shift and all-cause mortality. Safety outcomes included 24-h hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH), 90-day ICH. Inverse-probability weighting with truncation of extreme weights and additional adjustment for residual imbalance were applied. RESULTS: Among 1649 patients (mean age 78.0 ± 10.7 years; 47.8% men), 165 (10.0%) had PCI. PCI patients were more often on vitamin K antagonists and had lower stroke severity. After weighting, PCI was associated with a higher risk of the composite outcome (aHR 1.50, 95% CI 1.19-1.90; p < 0.001), vascular death (aHR 1.46, 95% CI 1.12-1.91; p = 0.005), all-cause mortality (aHR 1.85, 95% CI 1.51-2.27; p < 0.001), and worse mRS shift (aOR 1.79, 95% CI 1.51-2.13; p < 0.001). PCI was also associated with an increased risk of ICH (aHR 2.25, 95% CI 1.08-4.70; p = 0.031), whereas 24-HT and sICH were similar between groups. CONCLUSIONS: In AF patients with breakthrough stroke on OAC, PCI identifies a subgroup with worse 90-day outcomes. These findings support the prognostic relevance of infarct location."}