Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis

被引：7

作者：

Kim, Tae Jung ^{[1
,2
]}

Lee, Ji Sung ^{[3
]}

Yoon, Jae Sun ^{[1
]}

Oh, Mi Sun ^{[4
]}

Kim, Ji-Woo ^{[5
]}

Park, Soo-Hyun ^{[6
]}

Jung, Keun-Hwa ^{[1
]}

Kim, Hyun Young ^{[7
]}

Kwon, Jee-Hyun ^{[8
]}

Choi, Hye-Yeon ^{[9
]}

Kim, Hahn Young ^{[10
]}

Eah, Kyung Yoon ^{[11
]}

Han, Sang Won ^{[12
]}

Oh, Hyung-Geun ^{[13
]}

Kim, Young-Jae ^{[14
]}

Shin, Byoung-Soo ^{[15
]}

Kim, Chang Hun ^{[16
]}

Kim, Chi Kyung ^{[17
]}

Park, Jong-Moo ^{[18
]}

Lee, Kyung Bok ^{[19
]}

Park, Tai Hwan ^{[20
]}

Lee, Jun ^{[21
]}

Park, Man-Seok ^{[22
]}

Choi, Jay Chol ^{[23
]}

Kim, Chulho ^{[24
]}

Shin, Dong-Ick ^{[25
]}

Lee, Soo Joo ^{[26
]}

Kim, Dong-Eog ^{[27
]}

Cha, Jae-Kwan ^{[28
]}

Kim, Eung-Gyu ^{[29
]}

Yu, Kyung-Ho ^{[4
]}

Hong, Keun-Sik ^{[30
]}

Lee, Young-Seok ^{[31
]}

Lee, Ju-Hun ^{[32
]}

Sohn, Sung Il ^{[33
]}

Bae, Hee-Joon ^{[34
]}

Lee, Young-Bae ^{[35
]}

Lee, Jun Hong ^{[36
]}

Rha, Joung-Ho ^{[6
]}

Lee, Byung-Chul ^{[4
]}

Chang, Dae-Il ^{[37
]}

Ko, Sang-Bae ^{[1
,2
]}

Yoon, Byung-Woo ^{[18
]}

机构：

[1] Seoul Natl Univ, Dept Neurol, Coll Med, Seoul, South Korea

[2] Seoul Natl Univ Hosp, Dept Crit Care Med, Seoul, South Korea

[3] Univ Ulsan, Asan Med Ctr, Dept Clin Epidemiol & Biostat, Coll Med, Seoul, South Korea

[4] Hallym Univ, Dept Neurol, Sacred Heart Hosp, Anyang, South Korea

[5] Hlth Insurance Review & Assessment Serv, Wonju, South Korea

[6] Inha Univ Hosp, Dept Neurol, Incheon, South Korea

[7] Hanyang Univ Hosp, Dept Neurol, Seoul, South Korea

[8] Ulsan Univ Hosp, Dept Neurol, Ulsan, South Korea

[9] Kyung Hee Univ Hosp Gangdong, Dept Neurol, Seoul, South Korea

[10] Konkuk Univ, Dept Neurol, Sch Med, Seoul, South Korea

[11] Dongguk Univ, Dept Neurol, Coll Med, Gyeongju, South Korea

[12] Inje Univ, Dept Neurol, Coll Med, Seoul, South Korea

[13] Soonchunhyang Univ, Dept Neurol, Cheonan Hosp, Cheonan, South Korea

[14] Eunpyeong St Marys Hosp, Dept Neurol, Seoul, South Korea

[15] Chungbuk Natl Univ Hosp, Dept Neurol, Jeonju, South Korea

[16] Gyeongsang Natl Univ Hosp, Dept Neurol, Jinju, South Korea

[17] Korea Univ, Dept Neurol, Guro Hosp, Seoul, South Korea

[18] Uijeongbu Eulji Med Ctr, Dept Neurol, Uijongbu, South Korea

[19] Soonchunhyang Univ Hosp, Dept Neurol, Seoul, South Korea

[20] Seoul Med Ctr, Dept Neurol, Seoul, South Korea

[21] Yeungnam Univ Hosp, Dept Neurol, Daegu, South Korea

[22] Chonnam Natl Univ Hosp, Dept Neurol, Gwangju, South Korea

[23] Jeju Natl Univ Hosp, Dept Neurol, Jeju, South Korea

[24] Hallym Univ, Dept Neurol, Coll Med, Chunchon, South Korea

[25] Chungbuk Natl Univ Hosp, Dept Neurol, Cheongju, South Korea

[26] Daejeon Eulji Univ Hosp, Dept Neurol, Deajeon, South Korea

[27] Dongguk Univ, Dept Neurol, Ilsan Hosp, Goyang, South Korea

[28] Dong A Univ Hosp, Dept Neurol, Busan, South Korea

[29] Inje Univ, Dept Neurol, Busan Paik Hosp, Busan, South Korea

[30] Ilsan Paik Hosp, Dept Neurol, Goyang, South Korea

[31] Seoul Natl Univ, Dept Neurol, Seoul Metropolitan Govt, Boramae Med Ctr, Seoul, South Korea

[32] Kangdong Sacred Heart Hosp, Dept Neurol, Seoul, South Korea

[33] Keimyung Univ, Dept Neurol, Dongsan Hosp, Daegu, South Korea

[34] Seoul Natl Univ, Dept Neurol, Bundang Hosp, Seongnam, South Korea

[35] Gachon Univ, Dept Neurol, Gil Med Ctr, Incheon, South Korea

[36] Ilsan Hosp, Dept Neurol, Natl Hlth Insurance Serv, Goyang, South Korea

[37] Kyung Hee Univ Hosp, Dept Neurol, Seoul, South Korea

来源：

INTERNATIONAL JOURNAL OF STROKE | 2023年 / 18卷 / 07期

基金：

新加坡国家研究基金会;

关键词：

Antithrombotic; ischemic stroke; secondary prevention; atrial fibrillation; large artery atherosclerosis; treatment; PERCUTANEOUS CORONARY INTERVENTION; DIRECT ORAL ANTICOAGULANTS; ANTIPLATELET THERAPY; INVERSE PROBABILITY; PREVENTION; ASPIRIN; MULTICENTER; CLOPIDOGREL; SUBTYPE; DISEASE;

D O I：

10.1177/17474930231158211

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Optimal antithrombotic regimens to prevent recurrent stroke in patients with ischemic stroke due to atrial fibrillation (AF) and atherosclerotic large-vessel stenosis remain unknown. Aims: This study aimed to evaluate the effect of multiple antithrombotic therapies on outcomes at 1 year after ischemic stroke due to two or more causes. Methods: We identified 862 patients with ischemic stroke due to AF and large artery atherosclerosis from the linked data. These patients were categorized into three groups according to antithrombotic therapies at discharge: (1) antiplatelets, (2) oral anticoagulants (OAC), and (3) antiplatelets plus OAC. The study outcomes were recurrent ischemic stroke, composite outcomes for cardiovascular events, and major bleeding after 1 year. Inverse probability of treatment weighting (IPTW) was used to balance the three groups using propensity scores. Results: Among 862 patients, 169 (19.6%) were treated with antiplatelets, 405 (47.0%) were treated with OAC, and 288 (33.4%) were treated with antiplatelets and OAC. After applying IPTW, only OAC had a significant beneficial effect on the 1-year composite outcome (hazard ratio (HR): 0.37, 95% confidence interval (CI): 0.23-0.60, p < 0.001) and death (HR: 0.35, 95% CI: (0.19-0.63), p < 0.001). The combination of antiplatelet agents and OAC group had an increased risk of major bleeding complications (HR: 5.27, 95% CI: (1.31-21.16), p = 0.019). However, there was no significant difference in 1-year recurrent stroke events among the three groups. Conclusion: This study demonstrated that OAC monotherapy was associated with lower risks of composite outcome and death in patients at 1 year after ischemic stroke due to AF and atherosclerotic stenosis. In addition, the combination of an antiplatelet and OAC had a high risk of major bleeding.

引用

页码：812 / 820

页数：9

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