Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis.

Abstract

BACKGROUND:

Optimal antithrombotic regimens to prevent recurrent stroke in patients with ischemic stroke due to atrial fibrillation (AF) and atherosclerotic large-vessel stenosis remain unknown.

AIMS:

This study aimed to evaluate the effect of multiple antithrombotic therapies on outcomes at 1 year after ischemic stroke due to two or more causes.

METHODS:

We identified 862 patients with ischemic stroke due to AF and large artery atherosclerosis from the linked data. These patients were categorized into three groups according to antithrombotic therapies at discharge: (1) antiplatelets, (2) oral anticoagulants (OAC), and (3) antiplatelets plus OAC. The study outcomes were recurrent ischemic stroke, composite outcomes for cardiovascular events, and major bleeding after 1 year. Inverse probability of treatment weighting (IPTW) was used to balance the three groups using propensity scores.

RESULTS:

Among 862 patients, 169 (19.6%) were treated with antiplatelets, 405 (47.0%) were treated with OAC, and 288 (33.4%) were treated with antiplatelets and OAC. After applying IPTW, only OAC had a significant beneficial effect on the 1-year composite outcome (hazard ratio (HR): 0.37, 95% confidence interval (CI): 0.23-0.60, p < 0.001) and death (HR: 0.35, 95% CI: (0.19-0.63), p < 0.001). The combination of antiplatelet agents and OAC group had an increased risk of major bleeding complications (HR: 5.27, 95% CI: (1.31-21.16), p = 0.019). However, there was no significant difference in 1-year recurrent stroke events among the three groups.

CONCLUSION:

This study demonstrated that OAC monotherapy was associated with lower risks of composite outcome and death in patients at 1 year after ischemic stroke due to AF and atherosclerotic stenosis. In addition, the combination of an antiplatelet and OAC had a high risk of major bleeding.

• Authors: Tae Jung Kim, Ji Sung Lee, Jae Sun Yoon, Mi Sun Oh, Ji-Woo Kim, Soo-Hyun Park, Keun-Hwa Jung, Hyun Young Kim, Jee-Hyun Kwon, Hye-Yeon Choi, Hahn Young Kim, Kyung Yoon Eah, Sang Won Han, Hyung-Geun Oh, Young-Jae Kim, Byoung-Soo Shin, Chang Hun Kim, Chi Kyung Kim, Jong-Moo Park, Kyung Bok Lee, Tai Hwan Park, Jun Lee, Man-Seok Park, Jay Chol Choi, Chulho Kim, Dong-Ick Shin, Soo Joo Lee, Dong-Eog Kim, Jae-Kwan Cha, Eung-Gyu Kim, Kyung-Ho Yu, Keun-Sik Hong, Young-Seok Lee, Ju-Hun Lee, Sung Il Sohn, Hee-Joon Bae, Young-Bae Lee, Jun Hong Lee, Joung-Ho Rha, Byung-Chul Lee, Dae-Il Chang, Sang-Bae Ko, Byung-Woo Yoon
• Journal: International journal of stroke : official journal of the International Stroke Society (Int J Stroke) Vol. 18 Issue 7 Pg. 812-820 (08 2023) ISSN: 1747-4949 [Electronic] United States
• PMID: 36748980 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Fibrinolytic Agents
• Platelet Aggregation Inhibitors
• Anticoagulants

Topics

• Humans
• Fibrinolytic Agents (adverse effects)
• Atrial Fibrillation (complications, drug therapy)
• Ischemic Stroke (drug therapy)
• Stroke (complications, drug therapy, prevention & control)
• Constriction, Pathologic
• Treatment Outcome
• Risk Factors
• Platelet Aggregation Inhibitors (adverse effects)
• Anticoagulants (adverse effects)
• Hemorrhage (chemically induced)
• Atherosclerosis (complications, drug therapy)
• Arteries
• Administration, Oral