1. Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis.
- Author
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Kim TJ, Lee JS, Yoon JS, Oh MS, Kim JW, Park SH, Jung KH, Kim HY, Kwon JH, Choi HY, Kim HY, Eah KY, Han SW, Oh HG, Kim YJ, Shin BS, Kim CH, Kim CK, Park JM, Lee KB, Park TH, Lee J, Park MS, Choi JC, Kim C, Shin DI, Lee SJ, Kim DE, Cha JK, Kim EG, Yu KH, Hong KS, Lee YS, Lee JH, Sohn SI, Bae HJ, Lee YB, Lee JH, Rha JH, Lee BC, Chang DI, Ko SB, and Yoon BW
- Subjects
- Humans, Fibrinolytic Agents adverse effects, Constriction, Pathologic, Treatment Outcome, Risk Factors, Platelet Aggregation Inhibitors adverse effects, Anticoagulants adverse effects, Hemorrhage chemically induced, Arteries, Administration, Oral, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Ischemic Stroke drug therapy, Stroke complications, Stroke drug therapy, Stroke prevention & control, Atherosclerosis complications, Atherosclerosis drug therapy
- 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.
- Published
- 2023
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