Antithrombotic Therapy After Acute Ischemic Stroke in Patients With Atrial Fibrillation

Study Questions:

What is the best antithrombotic regimen for prevention of secondary events in patients with atrial fibrillation (AF) who have had an ischemic stroke (IS)?


Data from 2,162 patients (mean age 78.1 years) who were hospitalized because of an IS and who had AF were obtained from a Canadian stroke registry. The primary study outcome was the composite of death or hospitalization for recurrent IS, myocardial infarction, or major bleeding.


Upon hospital discharge after an IS, 21.6% of patients were taking antiplatelet therapy alone, 39.3% were taking only an oral anticoagulant (OAC), 31.1% were taking an OAC plus antiplatelet therapy, and 8% were prescribed no antithrombotic therapy. The primary outcome occurred in 68% of patients during a median follow-up of 3.3 years. After correction for confounding variables, compared to OAC therapy by itself, therapy with an antiplatelet agent (hazard ratio [HR], 1.31) or with no antithrombotic therapy (HR, 1.51) was associated with a significantly higher risk of the primary outcome. There was a trend toward lower risk of the primary outcome in patients taking an OAC plus antiplatelet therapy compared to patients taking only an OAC (HR, 0.91).


The authors concluded that absence of treatment with an OAC exposes patients with AF to a significantly higher risk of secondary events after an IS.


It is surprising that approximately 30% of patients with AF who had an IS were discharged from the hospital without OAC therapy. It is possible that an OAC was not prescribed in some of these patients because of a perceived high risk of bleeding complications. However, the primary outcome included major bleeds, and it is clear that the benefit of OACs outweighed their risk.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anticoagulants, Atrial Fibrillation, Canada, Confounding Factors (Epidemiology), Fibrinolytic Agents, Stroke, Registries, Myocardial Infarction, Patient Discharge, Platelet Aggregation Inhibitors

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