Effectiveness of Adding Antiplatelets to Oral Anticoagulants in Patients with Acute Ischemic Stroke with Atrial Fibrilla
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ORIGINAL ARTICLE
Effectiveness of Adding Antiplatelets to Oral Anticoagulants in Patients with Acute Ischemic Stroke with Atrial Fibrillation and Concomitant Large Artery Steno-Occlusion Joon-Tae Kim 1 & Ji Sung Lee 2 & Beom Joon Kim 3 & Jong-Moo Park 4 & Kyusik Kang 4 & Soo Joo Lee 5 & Jae Guk Kim 5 & Jae-Kwan Cha 6 & Dae-Hyun Kim 6 & Tai Hwan Park 7 & Sang-Soon Park 7 & Kyung Bok Lee 8 & Jun Lee 9 & Keun-Sik Hong 10 & Yong-Jin Cho 10 & Hong-Kyun Park 10 & Byung-Chul Lee 11 & Kyung-Ho Yu 11 & Mi Sun Oh 11 & Dong-Eog Kim 12 & Wi-Sun Ryu 12 & Jay Chol Choi 13 & Jee-Hyun Kwon 14 & Wook-Joo Kim 14 & Dong-Ick Shin 15 & Sung Il Sohn 16 & Jeong-Ho Hong 16 & Man-Seok Park 1 & Kang-Ho Choi 1 & Ki-Hyun Cho 1 & Juneyoung Lee 17 & Philip B. Gorelick 18,19 & Hee-Joon Bae 3 Received: 30 January 2020 / Revised: 10 May 2020 / Accepted: 13 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Stroke . Atrial fibrillation . Large artery steno-occlusion . Oral anticoagulant . Antiplatelet
Introduction Cardioembolic stroke, mainly due to atrial fibrillation (AF), accounts for 20 to 25% of ischemic stroke [1, 2]. AF Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12975-020-00822-z) contains supplementary material, which is available to authorized users. * Joon-Tae Kim
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