Effectiveness of Adding Antiplatelets to Oral Anticoagulants in Patients with Acute Ischemic Stroke with Atrial Fibrillation and Concomitant Large Artery Steno-Occlusion.

Abstract

We investigated the effectiveness of adding antiplatelet (AP) to oral anticoagulant (OAC) treatment versus OAC treatment alone in patients with AIS with atrial fibrillation (AF) and significant large artery steno-occlusion (LASO). This study is a retrospective analysis of a nationwide, prospective, multicenter stroke registry between April 2008 and November 2017. Patients with acute (within 48 h of onset) and mild-to-moderate (NIHSS score ≤ 15) stroke with AF and concomitant LASO were identified. Antithrombotic regimens at discharge were categorized into OAC alone or OAC + AP. The primary outcome event was a composite of recurrent stroke, myocardial infarction, and all-cause mortality within 3 months of stroke. Among the 2553 patients (age, 73 ± 10 years; men, 50.4%), 78.8% were treated with OAC alone, and 21.2% were treated with OAC + AP. The primary outcome events were significantly more common in the OAC + AP group (6.7%) than the OAC alone group (4.3%) (p = 0.02). Weighted Cox proportional hazard analysis showed that OAC + AP increased the risk of 3-month primary outcome events compared with OAC alone (HR, 1.62 [1.06 to 2.46]). A potential interaction between the type of LASO and discharge antithrombotics was suggested (Pinteraction = 0.04); unlike in patients with complete occlusion (OAC + AP; HR, 2.00 [1.27-3.15]), OAC + AP was comparable with OAC alone for 3-month primary outcome in patients with moderate-to-severe stenosis (HR, 0.54 [0.17-1.70]). In conclusion, OAC + AP might increase the risk of 3-month outcome events compared with OAC alone in patients with AIS with AF and concomitant LASO. However, the effect of additional AP to OAC might differ according to LASO type.

• Authors: Joon-Tae Kim, Ji Sung Lee, Beom Joon Kim, Jong-Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Jae-Kwan Cha, Dae-Hyun Kim, Tai Hwan Park, Sang-Soon Park, Kyung Bok Lee, Jun Lee, Keun-Sik Hong, Yong-Jin Cho, Hong-Kyun Park, Byung-Chul Lee, Kyung-Ho Yu, Mi Sun Oh, Dong-Eog Kim, Wi-Sun Ryu, Jay Chol Choi, Jee-Hyun Kwon, Wook-Joo Kim, Dong-Ick Shin, Sung Il Sohn, Jeong-Ho Hong, Man-Seok Park, Kang-Ho Choi, Ki-Hyun Cho, Juneyoung Lee, Philip B Gorelick, Hee-Joon Bae
• Journal: Translational stroke research (Transl Stroke Res) Vol. 11 Issue 6 Pg. 1322-1331 (12 2020) ISSN: 1868-601X [Electronic] United States
• PMID: 32472251 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors

Topics

• Administration, Oral
• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage)
• Atrial Fibrillation (diagnosis, drug therapy, epidemiology)
• Brain Ischemia (diagnosis, drug therapy, epidemiology)
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Humans
• Ischemic Stroke (diagnosis, drug therapy, epidemiology)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage)
• Prospective Studies
• Registries
• Republic of Korea (epidemiology)
• Retrospective Studies
• Treatment Outcome