Short-term combination therapy with an oral anticoagulant and antiplatelet agent reduced the risk of recurrent ischemic stroke (OR 0.37) compared to oral anticoagulant monotherapy in patients with atrial fibrillation and large artery atherosclerosis.
Meta-Analysis (n=7,437)
Does oral anticoagulant plus antiplatelet therapy reduce recurrent ischemic stroke compared to oral anticoagulant monotherapy in patients with ischemic stroke, atrial fibrillation, and large artery atherosclerosis?
In patients with ischemic stroke, AF, and LAA, long-term OAC plus antiplatelet therapy increases bleeding and mortality without preventing recurrent stroke, though short-term combination therapy may reduce early recurrent stroke.
Effect estimate: OR 0.37 (95% CI 0.14-0.97)
p-value: p=0.043
Background and Purpose Patients with ischemic stroke with both atrial fibrillation (AF) and large artery atherosclerosis (LAA) represent therapeutic challenges, and the optimal antithrombotic regimen remains uncertain. We conducted a meta-analysis comparing oral anticoagulant (OAC) monotherapy with OAC plus antiplatelet therapy in this population.Methods PubMed and EMBASE were searched through June 30, 2025, for studies enrolling patients with ischemic stroke and evidence of both AF and LAA. Outcomes included recurrent ischemic stroke, major bleeding, all-cause mortality, and a composite outcome. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Peto method, with random-effects sensitivity analyses, stratified by short-term (p=0.043), without a significant increase in major bleeding, although this association did not persist under random-effects sensitivity analysis (OR, 0.37; 95% CI, 0.13–1.07; p=0.067). Conversely, long-term combination therapy was associated with higher risks of major bleeding (OR, 1.25; 95% CI, 1.08–1.45; p=0.002), all-cause mortality (OR, 1.25; 95% CI, 1.01–1.54; p=0.039), and composite outcome (OR, 1.49; 95% CI, 1.27–1.74; pp=0.054).Conclusions While long-term OAC plus antiplatelet therapy increases bleeding risk without preventing recurrent stroke, short-term combination therapy may offer benefits in selected patients with concomitant LAA, though this early efficacy signal should be interpreted with caution.
Lee et al. (Fri,) conducted a meta-analysis in Ischemic stroke with atrial fibrillation and large artery atherosclerosis (n=7,437). Oral anticoagulant plus antiplatelet therapy vs. Oral anticoagulant monotherapy was evaluated on Short-term (<3 months) recurrent ischemic stroke (OR 0.37, 95% CI 0.14-0.97, p=0.043). Short-term combination therapy with an oral anticoagulant and antiplatelet agent reduced the risk of recurrent ischemic stroke (OR 0.37) compared to oral anticoagulant monotherapy in patients with atrial fibrillation and large artery atherosclerosis.