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Optimal use of antithrombotic agents in recent small subcortical strokes accompanied by atrial fibrillation
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Optimal use of antithrombotic agents in recent small subcortical strokes accompanied by atrial fibrillation
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Journal Article
Optimal use of antithrombotic agents in recent small subcortical strokes accompanied by atrial fibrillation
2024
Overview
Background:
This study aimed to evaluate the efficacy and safety of anticoagulants (AC) and antiplatelets (APT) in patients with recent small subcortical infarctions (RSSI) and atrial fibrillation (AF).
Methods:
We utilized a prospective multicenter stroke registry database to identify patients with RSSI with a concurrent diagnosis of AF. Propensity score matching analysis was used to balance baseline differences among the AC-only, APT-only, and their combination groups. The main outcomes of interest were time to occurrence of minor and major bleeding, stroke recurrence, and all-cause mortality. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for each outcome were calculated using the multivariable Cox proportional hazard regression analysis.
Results:
Of the 404 eligible patients, 28.2% received APT only, 53.0% received AC only, and 18.9% received a combination of both. Notable differences were observed between these groups in terms of the 1-year stroke recurrence (APT, 32.5%; AC, 5.6%; APT + AC, 9.2%) and all-cause mortality (APT, 21.9%; AC, 6.1%; APT + AC, 14.5%), whereas the rates of bleeding events were comparable. The multivariable analysis indicated a significant association of AC alone with reduced risks of severe bleeding, stroke recurrence, and all-cause mortality compared with APT alone (aHR 0.64, 95% CI 0.41–0.98; aHR 0.11, 95% CI 0.06–0.22; aHR 0.22, 95% CI 0.11–0.44, respectively). The combination group showed a reduced risk of stroke recurrence compared to APT alone (aHR 0.19, 95% CI 0.08–0.46). These findings remained consistent with the propensity score-matched analysis.
Conclusion:
AC showed better clinical outcomes than APT in patients with RSSI and AF. Additionally, combination therapy with AC and APT was associated with a lower risk of stroke recurrence than APT alone.
Graphical abstract
Publisher
SAGE Publications,Oxford University Press
Subject
/ Anticoagulants - administration & dosage
/ Anticoagulants - adverse effects
/ Anticoagulants - therapeutic use
/ Atrial Fibrillation - complications
/ Atrial Fibrillation - drug therapy
/ Atrial Fibrillation - mortality
/ Female
/ Fibrinolytic Agents - administration & dosage
/ Fibrinolytic Agents - therapeutic use
/ Hemorrhage - chemically induced
/ Humans
/ Male
/ Original
/ Platelet Aggregation Inhibitors - administration & dosage
/ Platelet Aggregation Inhibitors - therapeutic use
/ Stroke
