Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis
- Authors
- Kim, Tae Jung; Lee, Ji Sung; Yoon, Jae Sun; Oh, Mi Sun; Kim, Ji-Woo; Park, Soo-Hyun; Jung, Keun-Hwa; Kim, Hyun Young; Kwon, Jee-Hyun; Choi, Hye-Yeon; Kim, Hahn Young; Eah, Kyung Yoon; Han, Sang Won; Oh, Hyung-Geun; Kim, Young-Jae; Shin, Byoung-Soo; Kim, Chang Hun; Kim, Chi Kyung; Park, Jong-Moo; Lee, Kyung Bok; Park, Tai Hwan; Lee, Jun; Park, Man-Seok; Choi, Jay Chol; Kim, Chulho; Shin, Dong-Ick; Lee, Soo Joo; Kim, Dong-Eog; Cha, Jae-Kwan; Kim, Eung-Gyu; Yu, Kyung-Ho; Hong, Keun-Sik; Lee, Young-Seok; Lee, Ju-Hun; Sohn, Sung Il; Bae, Hee-Joon; Lee, Young-Bae; Lee, Jun Hong; Rha, Joung-Ho; Lee, Byung-Chul; Chang, Dae-Il; Ko, Sang-Bae; Yoon, Byung-Woo
- Issue Date
- Aug-2023
- Publisher
- SAGE PUBLICATIONS LTD
- Keywords
- Antithrombotic; ischemic stroke; secondary prevention; atrial fibrillation; large artery atherosclerosis; treatment
- Citation
- INTERNATIONAL JOURNAL OF STROKE, v.18, no.7, pp.812 - 820
- Journal Title
- INTERNATIONAL JOURNAL OF STROKE
- Volume
- 18
- Number
- 7
- Start Page
- 812
- End Page
- 820
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/88726
- DOI
- 10.1177/17474930231158211
- ISSN
- 1747-4930
- 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.
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