Bleeding May Outpace Ischemic Recurrence in Young Stroke Survivors

This prospective Dutch cohort quantifies long-term bleeding burden of antithrombotic therapy in stroke survivors aged 18 to 49, a group systematically underrepresented in the secondary prevention trials that anchor current guidelines.

aspirinclopidogrelticagrelordipyridamoleantiplatelet therapydirect oral anticoagulantsvitamin K antagonistslow-molecular-weight heparinischemic strokeyoung adultssecondary preventionbleeding riskcardioembolic strokepatent foramen ovalecohort studyODYSSEY Cardiology / Anticoagulation

Background Information

Young stroke survivors face significant bleeding risk on antithrombotic therapy.

The study addresses the balance between the benefits and risks of antithrombotic therapy in young adults after ischemic stroke, focusing on bleeding risk. Among 1226 young stroke survivors, the 5-year cumulative risk of bleeding was 10.7%, with an annual rate of 2.5 events per 100 person-years. Results suggest that bleeding risks can surpass recurrent vascular events in young stroke survivors on long-term antithrombotic therapy, emphasizing the need for careful risk assessment. Long-term antithrombotic therapy in young stroke survivors comes with notable bleeding risks that should be carefully managed.

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Authors: Rasing A, Verburgt E, Ekker MS, Schellekens MMI, Immens MHM, Verhoeven JI, Boot EM, van Alebeek ME, Brouwers PJAM, Arntz RM, van Dijk GW, van Uden IWM, Gons RAR, den Heijer T, van Tuijl JH, de Laat KF, van Norden AGW, Vermeer SE, van Zagten MSG, van Oostenbrugge RJ, Wermer MJH, Nederkoorn PJ, Kerkhoff H, Rooyer FA, van Rooij FG, van den Wijngaard IR, Ten Cate TJF, Tuladhar AM, Richard E, de Leeuw FE, Hilkens NA

Citation: Rasing A, Verburgt E, Ekker MS, et al. Antithrombotic Therapy and Bleeding Risk Among Young Adults After Ischemic Stroke. JAMA network open. 2026;9(9):e2635826. doi:10.1001/jamanetworkopen.2026.35826

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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