Combined use of oral anticoagulants and antiplatelets did not significantly reduce the 1-year all-composite outcome (HR 0.91) compared to oral anticoagulants alone in patients with stroke, nonvalvular atrial fibrillation, and systemic atherosclerosis.
Cohort (n=445)
No
Does OAC plus antiplatelet therapy improve one-year outcomes compared to OAC alone in patients with ischemic stroke, NVAF, and systemic atherosclerosis?
In patients with NVAF and systemic atherosclerosis after an ischemic stroke, adding an antiplatelet to OAC may reduce all-cause mortality and MI but increase the risk of recurrent ischemic stroke.
Effect estimate: HR 0.91 (95% CI 0.55-1.50)
Absolute Event Rate: 19.4% vs 21.1%
p-value: p=0.709
This study aimed to investigate whether there was a difference in one-year outcome after stroke between patients treated with antiplatelet and anticoagulation (OAC + antiplatelet) and those with anticoagulation only (OAC), when comorbid atherosclerotic disease was present with non-valvular atrial fibrillation (NVAF). This was a retrospective study using a prospective cohort of consecutive patients with ischemic stroke. Patients with NVAF and comorbid atherosclerotic disease were assigned to the OAC + antiplatelet or OAC group based on discharge medication. All-cause mortality, recurrent ischemic stroke, hemorrhagic stroke, myocardial infarction, and bleeding events within 1 year after the index stroke were compared. Of the 445 patients included in this study, 149 (33.5%) were treated with OAC + antiplatelet. There were no significant differences in all outcomes between groups. After inverse probability of treatment weighting, OAC + antiplatelet was associated with a lower risk of all-cause mortality (hazard ratio 0.48; 95% confidence interval 0.23-0.98; P = 0.045) and myocardial infarction (0% vs. 3.0%, P < 0.001). The risk of hemorrhagic stroke was not significantly different (P = 0.123). OAC + antiplatelet was associated with a decreased risk of all-cause mortality and myocardial infarction but an increased risk of ischemic stroke among patients with NVAF and systemic atherosclerotic diseases.
Heo et al. (Wed,) conducted a cohort in Ischemic stroke with nonvalvular atrial fibrillation and systemic atherosclerosis (n=445). Oral anticoagulant (OAC) plus antiplatelet vs. Oral anticoagulant (OAC) alone was evaluated on All-composite outcome within 1 year (HR 0.91, 95% CI 0.55-1.50, p=0.709). Combined use of oral anticoagulants and antiplatelets did not significantly reduce the 1-year all-composite outcome (HR 0.91) compared to oral anticoagulants alone in patients with stroke, nonvalvular atrial fibrillation, and systemic atherosclerosis.