Why the study?
The study investigated the effect of D-dimer levels and the efficacy of different antithrombotic therapies according to baseline D-dimer levels on recurrent stroke in patients with AF-related stroke and atherosclerosis.
Do anticoagulants reduce recurrent ischemic stroke compared to antiplatelets in patients with AF-related stroke and atherosclerosis, particularly those with high D-dimer levels?
Do anticoagulants reduce recurrent ischemic stroke compared to antiplatelets in patients with AF-related stroke and atherosclerosis, particularly those with high D-dimer levels?
High baseline D-dimer levels (≥2 μg/mL) can identify patients with AF-related stroke and atherosclerosis who derive significantly greater benefit from anticoagulants over antiplatelets for secondary stroke prevention.
May support D-dimer-guided risk stratification in AF-related stroke; leaves open optimal antithrombotic selection pending trials.
Background: We investigated the effect of D-dimer levels and efficacy of different antithrombotic therapies according to the baseline D-dimer levels on recurrent stroke in patients with atrial fibrillation (AF)-related stroke and atherosclerosis. Methods: We enrolled 1441 patients with AF-related stroke and atherosclerosis in this nationwide multicenter study. The primary outcome measure was the occurrence of recurrent ischemic stroke over a 3-year period. Results: High D-dimer levels (≥2 μg/mL) were significantly associated with higher risk of recurrent ischemic stroke (adjusted hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.13–2.84; p = 0.012). The risk of recurrent stroke was similar between the anticoagulant and the antiplatelet groups in all subjects (adjusted HR, 0.78; 95% CI, 0.46–1.32; p = 0.369). However, in patients with high D-dimer levels (≥2 μg/mL), risk of recurrent stroke was significantly lower in the anticoagulant group than in the antiplatelet group (adjusted HR, 0.40; 95% CI, 0.18–0.87; p = 0.022). Conclusion: Our findings suggested that baseline D-dimer levels could be used as a risk assessment biomarker of recurrent stroke in patients with AF-related stroke and atherosclerosis. High D-dimer levels would facilitate the identification of patients who are more likely to benefit from anticoagulants to ensure secondary prevention of stroke.
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Choi et al. (2019) studied this question.
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