Key result
In atrial fibrillation patients who underwent endovascular treatment and carotid artery stenting, 90-day mortality was significantly lower in those receiving oral anticoagulation plus antiplatelet therapy compared to dual antiplatelet therapy alone (4% vs 32%, p=0.02).
Why the study?
In patients with AF and large vessel occlusion stroke undergoing endovascular therapy and acute carotid artery stenting, the optimal antithrombotic regimen remains unclear.
Does dual antiplatelet therapy without oral anticoagulation increase 90-day mortality compared to oral anticoagulation plus antiplatelet therapy in acute ischemic stroke patients with atrial fibrillation undergoing endovascular therapy and carotid artery stenting?
Cohort (n=82)
Yes
Does dual antiplatelet therapy without oral anticoagulation increase 90-day mortality compared to oral anticoagulation plus antiplatelet therapy in acute ischemic stroke patients with atrial fibrillation undergoing endovascular therapy and carotid artery stenting?
Absolute Event Rate: 4% vs 32%
p-value: p=0.02
In stroke patients with atrial fibrillation undergoing endovascular therapy and carotid stenting, omitting oral anticoagulation at discharge in favor of dual antiplatelet therapy alone is associated with significantly higher 90-day mortality.
Caution against omitting oral anticoagulation post endovascular therapy and stenting in AF; leaves open need for randomized confirmation.
BACKGROUND: Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear. METHODS: This is a subgroup analysis of the German Stroke Registry-Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days. RESULTS: Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high. Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3-10.5] vs 7 [4-11], p = 0.73, mRS 4 [IQR 3-4] vs. 4 [IQR 3-5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02). CONCLUSIONS: In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC. REGISTRATION: https://www. CLINICALTRIALS: gov ; Unique identifier: NCT03356392.
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Weller et al. (2022) conducted a cohort in Acute ischemic stroke with atrial fibrillation (n=82). Oral anticoagulation plus single or dual antiplatelet therapy (OAC + (D)APT) vs. Dual antiplatelet therapy (DAPT) without OAC was evaluated on 90-day mortality (p=0.02). In atrial fibrillation patients who underwent endovascular treatment and carotid artery stenting, 90-day mortality was significantly lower in those receiving oral anticoagulation plus antiplatelet therapy compared to dual antiplatelet therapy alone (4% vs 32%, p=0.02).
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