Abstract Number: Esoc2026a2264 Recurrent Ischemic Stroke and Major Bleeding After Ischemic Stroke in Patients With Atrial Fibrillation on Oral Anticoagulants: A Nationwide Cohort Study

Abstract Background and aims Patients with atrial fibrillation (AF) treated with oral anticoagulants (OAC) after ischemic stroke (IS) remain at risk of recurrent IS while also being susceptible to major bleeding. Contemporary population-based data quantifying absolute risks of these outcomes are limited. We aimed to estimate cumulative incidences and incidence rates of recurrent IS, intracranial bleeding (ICB), and gastrointestinal bleeding (GIB) in AF patients treated with OAC after IS. Methods Using Danish nationwide registries, we included all patients aged ≥40 years with non-valvular AF hospitalized with IS between 2014-2024 and treated with OAC. Follow-up continued until first outcome (recurrent IS, ICB, or GIB) or censoring (death, emigration, or end-of-study). We estimated 2-year cumulative incidences accounting for competing risk of death (Aalen-Johansen estimator), and calculated incidence rates per 100 person-years for the entire follow-up period. Results We included 8,173 patients (mean SD age, 78.8 9.8 years; 46.5% women). Recurrent IS was the most frequent outcome (613 events), followed by GIB (474) and ICB (247). The cumulative incidence of recurrent IS accounting for competing risk of death was 5.5% at 2 years, compared with 2.1% for ICB and 3.8% for GIB. Patients with a history of stroke or bleeding before index stroke experienced substantially higher event rates. Overall incidence rates per 100 person-years were 2.8 for recurrent IS, 1.2 for ICB, and 2.1 for GIB, with marked increases with age. Conclusions AF patients treated with OAC after IS face substantial residual risks of recurrent IS and major bleeding, particularly among older patients and those with prior events. Conflict of interest Nothing to disclose