Combination of oral anticoagulant and antiplatelet therapy does not change the 1-year prognosis compared to oral anticoagulant alone in stroke patients with atherosclerosis and atrial fibrillation
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https://doi.org/10.26900/hsq.2493Keywords:
Non-valvular atrial fibrillation, systemic atherosclerosis, ischemic stroke, oral anticoagulants, antiplatelet therapyAbstract
This study aims to evaluate the effectiveness of combined antiplatelet and oral anticoagulant (OAC) therapy versus OAC therapy alone on one-year post-stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) and systemic atherosclerosis. A retrospective study was conducted using the recorded data of patients diagnosed with ischemic cerebrovascular disease between January 1, 2022, and January 1, 2023, at the Neurology Clinic, Afyonkarahisar Health Sciences University. Patients with non-valvular atrial fibrillation (NVAF) and systemic atherosclerosis were included in the study. Collected data included demographic information, medical history. Patients were divided into two groups based on the treatment regimen used at discharge: those receiving OAC alone and those receiving a combination of OAC and antiplatelet therapy. Clinical outcomes were evaluated within one year following the stroke. A total of 671 stroke patients were screened, and 565 (84.2%) had ischemic stroke. Among these, 113 (20%) had NVAF, and 53 had both NVAF and systemic atherosclerosis. Data from these 53 patients were analyzed. The mean age was 71.81±11.90 years, with a female gender ratio of 52.8%. Logistic regression analysis showed no statistically significant differences between the two treatment groups in terms of all-cause mortality, bleeding, recurrent stroke, and hemorrhagic stroke (p>0.05 for all comparisons). The combination of antiplatelet and OAC therapy did not demonstrate superiority over OAC therapy alone in reducing the risks of recurrent ischemic stroke, hemorrhagic stroke, myocardial infarction, and mortality in patients with NVAF and systemic atherosclerosis. These findings suggest that OAC therapy alone may provide sufficient protection in this patient population. Prospective studies with larger samples are needed to confirm these results.
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Friberg L, Rosenqvist M, Lindgren A, Terént A, Norrving B, Asplund K. High prevalence of atrial fibrillation among patients with ischemic stroke. Stroke. 2014;45:2599–605. doi: /10.1161/STROKEAHA.114.006070.
Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52. doi: 10.1161/STR.0000000000000375.
Sun W, Li G, Zeng X, Lai Z, Wang M, Ouyang Y, et al. Clinical and imaging characteristics of cerebral infarction in patients with nonvalvular atrial fibrillation combined with cerebral artery stenosis. J Atheroscler Thromb. 2018;25:720-32. doi: /10.5551/jat.43240.
Lehtola H, Airaksinen KEJ, Hartikainen P, Hartikainen JEK, Palomäki A, Nuotio I, et al. Stroke recurrence in patients with atrial fibrillation: Concomitant carotid artery stenosis doubles the risk. Eur J Neurol. 2017;24:719-25. doi: 10.1111/ene.13280.
Zhou G, Wang H, Zhang X, Yu L, Yao F, Li B, et al. Cerebral arteriosclerosis stenosis predicts poor short-term prognosis in non-valvular atrial fibrillation related cardioembolic stroke treated by reperfusion therapy. Clin Neurol Neurosurg. 2021;207:106738. doi: 10.1016/j.clineuro.2021.106738.
Chang Y-J, Ryu S-J, Lin S-K. Carotid artery stenosis in ischemic stroke patients with nonvalvular atrial fibrillation. Cerebrovasc Dis. 2002;13:16-20. doi: 10.1159/000047740.
Dentali F. Combined Aspirin–oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease. Arch Intern Med. 2007;167:117. doi: 10.1001/archinte.167.2.117.
Lamberts M, Olesen JB, Ruwald MH, Hansen CM, Karasoy D, Kristensen SL, et al. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention. Circulation 2012;126:1185–93. doi: 10.1161/CIRCULATIONAHA.112.114967.
Yasuda S, Kaikita K, Akao M, Ako J, Matoba T, Nakamura M, et al. Antithrombotic therapy for atrial fibrillation with stable coronary disease. N Eng J Med. 2019;381:1103-13. doi: 10.1056/NEJMoa1904143.
Matsumura-Nakano Y, Shizuta S, Komasa A, Morimoto T, Masuda H, Shiomi H, et al. Open-label randomized trial comparing oral anticoagulation with and without single antiplatelet therapy in patients with atrial fibrillation and stable coronary artery disease beyond 1 year after coronary stent implantation. Circulation 2019;139:604-16. doi: 10.1161/CIRCULATIONAHA.118.036768.
Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, et al. Rivaroxaban with or without Aspirin in stable cardiovascular disease. N Eng J Med. 2017;377:1319-30. doi: 10.1056/NEJMoa1709118.
Chen LY, Chung MK, Allen LA, Ezekowitz M, Furie KL, McCabe P, et al. Atrial fibrillation burden: Moving beyond atrial fibrillation as a binary entity: A scientific statement from the American Heart Association. Circulation. 2018;137. doi: 10.1161/CIR.0000000000000568.
Baseline characteristics of patients with atrial fibrillation: The AFFIRM Study. Am Heart J. 2002;143:991-1001. doi: 10.1067/mhj.2002.122875.
Becattini C, Dentali F, Camporese G, Sembolini A, Rancan E, Tonello C, et al. Carotid atherosclerosis and risk for ischemic stroke in patients with atrial fibrillation on oral anticoagulant treatment. Atherosclerosis 2018;271:177-81. doi: 10.1016/j.atherosclerosis.2018.02.004.
Tsai C-T, Chan Y-H, Liao J-N, Chen T-J, Lip GYH, Chen S-A, et al. The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis - A nationwide cohort study. BMC Med. 2024;22:113. doi: 10.1186/s12916-024-03338-7.
Kim TJ, Lee JS, Yoon JS, Oh MS, Kim J-W, Park S-H, et al. Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis. Int J Stroke. 2023;18:812-20. doi: 10.1177/17474930231158211.
Lamberts M, Gislason GH, Lip GYH, Lassen JF, Olesen JB, Mikkelsen AP, et al. Antiplatelet therapy for stable coronary artery disease in atrial fibrillation patients taking an oral anticoagulant. Circulation. 2014;129:1577-85. doi: 10.1161/CIRCULATIONAHA.113.004834.
Lee S-R, Rhee T-M, Kang D-Y, Choi E-K, Oh S, Lip GYH. Meta-analysis of oral anticoagulant monotherapy as an antithrombotic strategy in patients with stable coronary artery disease and nonvalvular atrial fibrillation. Am J Cardiol. 2019;124:879-85. doi: 10.1016/j.amjcard.2019.05.072.
Shakir A, Khan A, Agarwal S, Clifton S, Reese J, Munir MB, et al. Dual therapy with oral anticoagulation and single antiplatelet agent versus monotherapy with oral anticoagulation alone in patients with atrial fibrillation and stable ischemic heart disease: A systematic review and meta-analysis. J Interv Card Electrophysiol. 2022;66:493-506. doi: 10.1007/s10840-022-01347-1.
Espinola-Klein C. When and how to combine antiplatelet and anticoagulant drugs? Hamostaseologie. 2022;42:073-9. doi: 10.1055/a-1724-4922.
Wang Z, Korantzopoulos P, Liu T. Carotid atherosclerosis in patients with atrial fibrillation. Curr Atheroscler Rep. 2019;21:55. doi: 10.1007/s11883-019-0808-4.
Evans A, Perez I, Yu G, Kalra L. Should stroke subtype influence anticoagulation decisions to prevent recurrence in stroke patients with atrial fibrillation? Stroke. 2001;32:2828-32. doi: 10.1161/hs1201.099520.
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