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Antithrombotic treatment in patients with stroke and supracardiac atherosclerosis

Dimitrios Sagris1, Georgios Georgiopoulos1, Ioannis Leventis1

  • 1From the Department of Internal Medicine (D.S., I.L., K.M., G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; School of Biomedical Engineering and Imaging Sciences (G.G.), King's College, London, UK; Department of Biostatistics and Research Support (K.P.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; biostatistics consultant (L.A.P.), Minot, ND; Department of Clinical Therapeutics (E.K., K.V.), Alexandra Hospital, University of Athens, Greece; Imperial College London (E.K.), UK; and Department of Internal Medicine, School of Medicine (H.M.), University of Ioannina, Greece.

Neurology
|July 8, 2020
PubMed

Insights

Oral anticoagulants did not reduce recurrent ischemic stroke risk compared to antiplatelets in patients with stroke and supracardiac atherosclerosis. However, anticoagulants significantly increased the risk of major bleeding events.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Atherosclerosis in the aortic arch or cervical/intracranial arteries (supracardiac atherosclerosis) is a risk factor for stroke.
  • The optimal antithrombotic strategy for patients with stroke and supracardiac atherosclerosis remains debated.
  • Oral anticoagulants and antiplatelets are commonly used to prevent secondary stroke.

Purpose of the Study:

  • To compare the efficacy and safety of oral anticoagulants versus antiplatelets in patients experiencing stroke with co-existing supracardiac atherosclerosis.
  • To evaluate the impact of these treatments on recurrent ischemic stroke, major ischemic events or death, and bleeding complications.

Main Methods:

  • A systematic literature search was conducted on PubMed and Scopus up to August 28, 2019.
  • Included were randomized controlled trials (RCTs) comparing oral anticoagulants and antiplatelets in stroke patients with supracardiac atherosclerosis.
  • Meta-analysis using random-effects models was performed to estimate treatment effects (relative risk [RR] and 95% confidence interval [CI]).

Main Results:

  • Ten RCTs involving 6,068 patients were included.
  • Recurrent ischemic stroke rates were similar between anticoagulant and antiplatelet groups (RR, 0.91; 95% CI, 0.70-1.18).
  • Major bleeding rates were significantly higher in the anticoagulant group compared to the antiplatelet group (RR, 3.21; 95% CI, 1.96-5.24).

Conclusions:

  • In patients with stroke and supracardiac atherosclerosis, oral anticoagulants do not offer a significant benefit in reducing recurrent ischemic stroke compared to antiplatelets.
  • The use of oral anticoagulants is associated with a substantially increased risk of major bleeding.
  • Current evidence suggests antiplatelet therapy may be a safer alternative for stroke prevention in this patient population.
Abstract

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