ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1576250
Antithrombotic agents and effect on outcomes in ischemic stroke with atrial fibrillation and large artery atherosclerosis: a real-world study
Provisionally accepted
- 1The First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
- 2neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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The optimal antithrombotic regimen for preventing recurrent stroke in patients who experience ischemic stroke due to atrial fibrillation (AF) and atherosclerotic large-vessel stenosis remains unclear. The present study aimed to evaluate the effect of multiple antithrombotic therapies on outcomes after ischemic stroke due to ≥ 2 causes.Methods: Data from 632 patients at a single hospital, who experienced ischemic stroke due to AF and large-artery atherosclerosis. Patients were categorized into 3 groups according to antithrombotic therapy at discharge: antiplatelets (APT), oral anticoagulant(s) (OAC), and APT plus OAC. Study outcomes included recurrent ischemic stroke and composite outcomes for cardiovascular events, death and major bleeding. Propensity scores (PS) were used to balance APT and OAC groups.Results: Among 632 patients, 158 (25.0%) were treated with APT, 447 (70.7%) with OAC, and 27 (4.3%) with both 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 one-year recurrent stroke events or risk for bleeding between the APT and OAC groups. Further analysis of the relationship between the dose of OAC and outcome revealed no significant difference between reduced and standard doses of OAC.This study demonstrated that OAC monotherapy was associated with a lower risk for composite outcomes and death after ischemic stroke due to AF and atherosclerotic stenosis, although the OAC dose had no effect on clinical outcomes.
Keywords: Acute ischemic stroke, Atrial Fibrillation, antithrombotic agents, Anticoagulants, large artery atherosclerosis, Real world, effect
Received: 13 Feb 2025; Accepted: 26 May 2025.
Copyright: © 2025 Chen, Cheng, Ye, Liu, Zhang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zheng Zhang, neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
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