Key result
Anticoagulant therapy linked to ~65% lower mortality and excellent functional outcomes versus antiplatelets.
Why the study?
The efficacy and safety of anticoagulant therapy in patients with acute ischemic stroke and atrial fibrillation remain uncertain.
Does anticoagulant therapy improve functional outcomes and reduce mortality and bleeding compared to antiplatelet therapy in patients with acute ischemic stroke and atrial fibrillation?
Cohort (n=400)
No
Does anticoagulant therapy improve functional outcomes and reduce mortality and bleeding compared to antiplatelet therapy in patients with acute ischemic stroke and atrial fibrillation?
Effect estimate: aOR 2.63 (95% CI 1.61-4.30)
In patients with acute ischemic stroke and atrial fibrillation, anticoagulant therapy is associated with better functional outcomes, lower mortality, and reduced bleeding risk compared to antiplatelet therapy.
May support anticoagulants over antiplatelets for outcomes in acute stroke with AF; leaves open confirmation in randomized trials.
The efficacy and safety of anticoagulant therapy in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) remain uncertain. This study enrolled 431 AIS and AF patients from Nanjing Drum Tower Hospital between January 2019 and December 2021 and followed for 365 days to determine the associations between anticoagulants and clinical outcomes by assessing modified Rankin Scale (mRS) score, recurrent ischemic stroke/systemic embolism (IS/SE), all-cause mortality, intracranial hemorrhage (ICH) and major bleeding. Final analysis included 400 eligible patients and divided them into antiplatelet group (n = 191) and anticoagulant group (n = 209). Anticoagulant therapy was associated with excellent (mRS 0-1; adjusted odds ratio (aOR), 2.63; 95% confidence interval (CI), 1.61-4.30) and favorable functional outcomes (mRS 0-2; aOR, 2.82; 95% CI, 1.69-4.70) and lower risk of all-cause mortality (adjusted hazard ratio (aHR), 0.35; 95% CI, 0.21-0.57), ICH (aHR, 0.45; 95% CI, 0.23-0.87) and major bleeding (aHR, 0.51; 95% CI, 0.28-0.94), without increasing the risk of recurrent IS/SE (aHR, 0.75; 95% CI, 0.45-1.24). In conclusion, anticoagulant therapy may be a more effective and safer option than antiplatelet therapy for AIS patients with AF.
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Yan et al. (2023) conducted a cohort in Acute ischemic stroke with atrial fibrillation (n=400). Anticoagulant therapy vs. Antiplatelet therapy was evaluated on Excellent functional outcomes (mRS 0-1) (aOR 2.63, 95% CI 1.61-4.30). Anticoagulant therapy was associated with excellent functional outcomes (aOR 2.63; 95% CI 1.61-4.30) and lower all-cause mortality (aHR 0.35; 95% CI 0.21-0.57) compared to antiplatelet therapy.
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