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.
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Data used in this study are available upon reasonable request following submission of a legitimate academic research proposal to be assessed by the CRCS-K steering committee.
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This was supported by a grant (2017ER620101#) by the Research of Korea Centers for Disease Control and Prevention.
Conflict of Interest
The authors declare that they have no conflicts of interest.
H.-J.B is involved in the principal investigation, a member of the steering committee, and/or a site investigator of multicenter clinical trials or clinical studies sponsored by Otsuka Korea, Bayer, Boehringer Ingelheim, Handok Pharmaceutical Company, SK Chemicals, Pfizer, ESAI-Korea, Daewoong Pharmaceutical Co. Ltd., Daiichi Sankyo, AstraZeneca Korea, Dong-A Pharmaceutical, Yuhan Corporation, BMS Korea, Korean Drug Co., Ltd., Servier, Shire Korea Ltd., and Shin Poong Pharm. Co. Ltd.; served on the scientific advisory board for Amgen Asia Holding Limited; served as the consultant for Celltrion, Inc. and Korean Drug Co., Ltd.; and received lecture honoraria from Daiichi Sankyo Korea, Otsuka Korea, Esai Korea, Korean Drug Co., Ltd., and Shire Korea Ltd. (modest). PBG serves as a member of the ARRIVE Steering Committee for Bayer (modest).
The current study was approved by the local institutional review boards at all participating centers, including the Chonnam National University Hospital.
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Kim, J., Lee, J.S., Kim, B.J. et al. Effectiveness of Adding Antiplatelets to Oral Anticoagulants in Patients with Acute Ischemic Stroke with Atrial Fibrillation and Concomitant Large Artery Steno-Occlusion. Transl. Stroke Res. (2020). https://doi.org/10.1007/s12975-020-00822-z
- Atrial fibrillation
- Large artery steno-occlusion
- Oral anticoagulant