Antithrombotic agents and effect on outcomes in ischemic stroke with atrial fibrillation and large artery...

Area of Science:

• Cardiology
• Neurology
• Pharmacology

Background:

• Ischemic stroke in patients with atrial fibrillation (AF) and large-artery atherosclerosis presents a complex therapeutic challenge.
• Optimal antithrombotic strategies for secondary stroke prevention in this dual-risk population remain incompletely defined.

Purpose of the Study:

• To evaluate the comparative effectiveness of different antithrombotic regimens following ischemic stroke caused by both AF and atherosclerotic stenosis.
• To assess the impact of antiplatelet agents (APT), oral anticoagulants (OAC), and dual therapy on recurrent stroke, cardiovascular events, mortality, and bleeding.

Main Methods:

• Retrospective analysis of 632 patients with ischemic stroke due to AF and large-artery atherosclerosis.
• Patients were stratified into three groups: APT, OAC, or combined APT + OAC.
• Propensity score matching was employed to minimize confounding between the APT and OAC groups.

Main Results:

• OAC monotherapy demonstrated a significant reduction in composite cardiovascular outcomes (HR 0.41; p=0.01) and all-cause death (HR 0.12; p=0.05) compared to APT after propensity score adjustment.
• No significant differences were observed in one-year recurrent ischemic stroke rates or major bleeding risk between the OAC and APT groups.
• Neither reduced nor standard OAC doses showed a significant difference in clinical outcomes.

Conclusions:

• Oral anticoagulant monotherapy is associated with improved outcomes, specifically reduced composite events and mortality, in patients with ischemic stroke due to concurrent AF and atherosclerotic stenosis.
• The findings suggest OAC monotherapy as a potentially superior strategy over APT in this high-risk patient cohort.
• Antithrombotic agent dosage did not appear to influence the observed clinical outcomes.