Antithrombotic agents and the effect on outcome in ischemic stroke with atrial fibrillation and large artery atherosclerosis: an observational study

Abstract Background: Optimal antithrombotic regimens to prevent recurrent stroke in patients with ischemic stroke due to atrial fibrillation (AF) and atherosclerotic large-vessel stenosis remains unknown. This study aimed to evaluate the effect of multiple antithrombotic therapies on outcomes after ischemic stroke due to two or more causes. Methods: We identified 553 patients with ischemic stroke due to AF and large artery atherosclerosis from a single hospital. These patients were categorized into three groups according to antithrombotic therapies at discharge: 1) antiplatelets (APT), 2) oral anticoagulants (OAC), and 3) antiplatelets plus OAC. The study outcomes were recurrent ischemic stroke, composite outcomes for cardiovascular events and major bleeding. propensity scores were used to balance APT and OAC group. Results: Among 553 patients, 79 (14.3%) were treated with APT, 447 (80.8%) were treated with OAC, and 27 (4.9%) were treated with APT and OAC. After applying PS, only OAC had a significant beneficial effect on the composite outcome (hazard ratio [HR]: 0.41, 95% confidence interval [CI]:0.19–0.83, P = 0.01) and death (HR: 0.12, [95% CI:0.01–1.0], P = 0.05). However, there was no significant difference in 1-year recurrent stroke events or bleeding risk between APT and OAC groups. Further relation between dose of OAC and outcome found that there was no significant difference between reduced and standard dose of OAC. Conclusions: This study demonstrated that OAC monotherapy was associated with lower risks of composite outcome and death in patients after ischemic stroke due to AF and atherosclerotic stenosis. However, the dose of OAC had no effect on clinical outcome.