Oral anticoagulants plus antiplatelets increased the 1-year risk of recurrent stroke, myocardial infarction, and mortality compared to oral anticoagulants alone in acute ischemic stroke (HR 1.70).
Cohort (n=7,395)
Yes
Does adding antiplatelets to oral anticoagulants reduce the composite of recurrent stroke, myocardial infarction, and all-cause mortality compared to oral anticoagulants alone in patients with acute ischemic stroke and atrial fibrillation?
Higher CHA2DS2-VASc scores predict worse 1-year outcomes in patients with acute ischemic stroke and atrial fibrillation, and adding antiplatelets to oral anticoagulants does not improve outcomes compared to OAC alone, except potentially in those with scores ≥5.
Effect estimate: HR 1.70 (95% CI 1.35-2.13)
Absolute Event Rate: 15.6% vs 10.1%
p-value: p=<0.001
Abstract We investigated a multicenter registry to identify estimated event rates according to CHA2DS2-VASc scores in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). The additional effectiveness of antiplatelets (APs) plus oral anticoagulants (OACs) compared with OACs alone considering the CHA2DS2-VASc scores was also explored. This study retrospectively analyzed a multicenter stroke registry between Jan 2011 and Nov 2017, identifying patients with acute ischemic stroke with AF. The primary outcome event was a composite of recurrent stroke, myocardial infarction, and all-cause mortality within 1 year. A total of 7395 patients (age, 73 ± 10 years; men, 54.2%) were analyzed. The primary outcome events at one year ranged from 5.99% (95% CI 3.21–8.77) for a CHA2DS2-VASc score of 0 points to 30.45% (95% CI 24.93–35.97) for 7 or more points. After adjustments for covariates, 1-point increases in the CHA2DS2-VASc score consistently increased the risk of primary outcome events (aHR 1.10 1.06–1.15) at 1-year. Among OAC-treated patients at discharge (n = 5500), those treated with OAC + AP (vs. OAC alone) were more likely to experience vascular events, though among patients with a CHA2DS2-VASc score of 5 or higher, the risk of primary outcome in the OAC + AP group was comparable to that in the OAC alone group (P int = 0.01). Our study found that there were significant associations of increasing CHA2DS2-VASc scores with the increasing risk of vascular events at 1-year in AIS with AF. Further study would be warranted.
Lee et al. (Tue,) conducted a cohort in Acute ischemic stroke with atrial fibrillation (n=7,395). Oral anticoagulants plus antiplatelets (OAC + AP) vs. Oral anticoagulants alone (OAC) was evaluated on Composite of recurrent stroke, myocardial infarction, and all-cause mortality within 1 year (HR 1.70, 95% CI 1.35-2.13, p=<0.001). Oral anticoagulants plus antiplatelets increased the 1-year risk of recurrent stroke, myocardial infarction, and mortality compared to oral anticoagulants alone in acute ischemic stroke (HR 1.70).