Effectiveness of Adding Antiplatelets to Oral Anticoagulants in Patients with Acute Ischemic Stroke with Atrial Fibrillation and Concomitant Large Artery Steno-Occlusion
- Authors
- Kim, Joon-Tae; Lee, Ji Sung; Kim, Beom Joon; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Cho, Yong-Jin; Park, Hong-Kyun; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi Sun; Kim, Dong-Eog; Ryu, Wi-Sun; Choi, Jay Chol; Kwon, Jee-Hyun; Kim, Wook-Joo; Shin, Dong-Ick; Sohn, Sung Il; Hong, Jeong-Ho; Park, Man-Seok; Choi, Kang-Ho; Cho, Ki-Hyun; Lee, Juneyoung; Gorelick, Philip B.; Bae, Hee-Joon
- Issue Date
- 12월-2020
- Publisher
- SPRINGER
- Keywords
- Stroke; Atrial fibrillation; Large artery steno-occlusion; Oral anticoagulant; Antiplatelet
- Citation
- TRANSLATIONAL STROKE RESEARCH, v.11, no.6, pp.1322 - 1331
- Indexed
- SCIE
SCOPUS
- Journal Title
- TRANSLATIONAL STROKE RESEARCH
- Volume
- 11
- Number
- 6
- Start Page
- 1322
- End Page
- 1331
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/51403
- DOI
- 10.1007/s12975-020-00822-z
- ISSN
- 1868-4483
- 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 (P-interaction = 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.
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