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Effectiveness of Adding Antiplatelets to Oral Anticoagulants in Patients with Acute Ischemic Stroke with Atrial Fibrillation and Concomitant Large Artery Steno-Occlusion

Translational Stroke Research volume 11, pages 1322–1331 (2020)Cite this article

Abstract

We investigated the effectiveness of adding antiplatelet (AP) to oral anticoagulant (OAC) treatment versus OAC treatment alone in patients with AIS with atrial fibrillation (AF) and significant large artery steno-occlusion (LASO). This study is a retrospective analysis of a nationwide, prospective, multicenter stroke registry between April 2008 and November 2017. Patients with acute (within 48 h of onset) and mild-to-moderate (NIHSS score ≤ 15) stroke with AF and concomitant LASO were identified. Antithrombotic regimens at discharge were categorized into OAC alone or OAC + AP. The primary outcome event was a composite of recurrent stroke, myocardial infarction, and all-cause mortality within 3 months of stroke. Among the 2553 patients (age, 73 ± 10 years; men, 50.4%), 78.8% were treated with OAC alone, and 21.2% were treated with OAC + AP. The primary outcome events were significantly more common in the OAC + AP group (6.7%) than the OAC alone group (4.3%) (p = 0.02). Weighted Cox proportional hazard analysis showed that OAC + AP increased the risk of 3-month primary outcome events compared with OAC alone (HR, 1.62 [1.06 to 2.46]). A potential interaction between the type of LASO and discharge antithrombotics was suggested (Pinteraction = 0.04); unlike in patients with complete occlusion (OAC + AP; HR, 2.00 [1.27–3.15]), OAC + AP was comparable with OAC alone for 3-month primary outcome in patients with moderate-to-severe stenosis (HR, 0.54 [0.17–1.70]). In conclusion, OAC + AP might increase the risk of 3-month outcome events compared with OAC alone in patients with AIS with AF and concomitant LASO. However, the effect of additional AP to OAC might differ according to LASO type.

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Fig. 1

Availability of Data and Material

Data used in this study are available upon reasonable request following submission of a legitimate academic research proposal to be assessed by the CRCS-K steering committee.

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Funding

This was supported by a grant (2017ER620101#) by the Research of Korea Centers for Disease Control and Prevention.

Author information

Affiliations

  1. Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea

    Joon-Tae Kim, Man-Seok Park, Kang-Ho Choi & Ki-Hyun Cho

  2. Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Ji Sung Lee

  3. Department of Neurology, Seoul National University College of Medicine, Cerebrovascular Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea

    Beom Joon Kim & Hee-Joon Bae

  4. Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea

    Jong-Moo Park & Kyusik Kang

  5. Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, South Korea

    Soo Joo Lee & Jae Guk Kim

  6. Department of Neurology, Dong-A University Hospital, Busan, South Korea

    Jae-Kwan Cha & Dae-Hyun Kim

  7. Department of Neurology, Seoul Medical Center, Seoul, South Korea

    Tai Hwan Park & Sang-Soon Park

  8. Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea

    Kyung Bok Lee

  9. Department of Neurology, Yeungnam University Hospital, Daegu, South Korea

    Jun Lee

  10. Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea

    Keun-Sik Hong, Yong-Jin Cho & Hong-Kyun Park

  11. Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea

    Byung-Chul Lee, Kyung-Ho Yu & Mi Sun Oh

  12. Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea

    Dong-Eog Kim & Wi-Sun Ryu

  13. Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea

    Jay Chol Choi

  14. Department of Neurology, Ulsan University College of Medicine, Ulsan, South Korea

    Jee-Hyun Kwon & Wook-Joo Kim

  15. Department of Neurology, Chungbuk National University Hospital, Cheongju, South Korea

    Dong-Ick Shin

  16. Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea

    Sung Il Sohn & Jeong-Ho Hong

  17. Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea

    Juneyoung Lee

  18. Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA

    Philip B. Gorelick

  19. Department of Translational Neuroscience, Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    Philip B. Gorelick

Authors
  1. Joon-Tae Kim
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  2. Ji Sung Lee
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  13. Jun Lee
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  33. Hee-Joon Bae
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Corresponding authors

Correspondence to Joon-Tae Kim or Hee-Joon Bae.

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Conflict of Interest

The authors declare that they have no conflicts of interest.

Disclosures

H.-J.B is involved in the principal investigation, a member of the steering committee, and/or a site investigator of multicenter clinical trials or clinical studies sponsored by Otsuka Korea, Bayer, Boehringer Ingelheim, Handok Pharmaceutical Company, SK Chemicals, Pfizer, ESAI-Korea, Daewoong Pharmaceutical Co. Ltd., Daiichi Sankyo, AstraZeneca Korea, Dong-A Pharmaceutical, Yuhan Corporation, BMS Korea, Korean Drug Co., Ltd., Servier, Shire Korea Ltd., and Shin Poong Pharm. Co. Ltd.; served on the scientific advisory board for Amgen Asia Holding Limited; served as the consultant for Celltrion, Inc. and Korean Drug Co., Ltd.; and received lecture honoraria from Daiichi Sankyo Korea, Otsuka Korea, Esai Korea, Korean Drug Co., Ltd., and Shire Korea Ltd. (modest). PBG serves as a member of the ARRIVE Steering Committee for Bayer (modest).

Ethics Approval

The current study was approved by the local institutional review boards at all participating centers, including the Chonnam National University Hospital.

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The requirement for a written informed consent from the study subjects was waived based on maintenance of study subject anonymity and minimal risk to the participants.

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Kim, JT., Lee, J.S., Kim, B.J. et al. Effectiveness of Adding Antiplatelets to Oral Anticoagulants in Patients with Acute Ischemic Stroke with Atrial Fibrillation and Concomitant Large Artery Steno-Occlusion. Transl. Stroke Res. 11, 1322–1331 (2020). https://doi.org/10.1007/s12975-020-00822-z

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Keywords

  • Stroke
  • Atrial fibrillation
  • Large artery steno-occlusion
  • Oral anticoagulant
  • Antiplatelet