Arrhythmias & electrophysiologyCohort study
Association between antithrombotic therapy after stroke in patients with atrial fibrillation and the risk of net clinical outcome: an observational cohort study
- Retrospective cohort study
- single-centre
Authors' conclusion
Approximately one-third of acute IS in AF have a distinctive mechanism from cardioembolism. Although APT was frequently prescribed in post-stroke patients with AF, no additive clinical benefit was observed.
Study context
- Population
- Patients with atrial fibrillation (AF) admitted for acute ischaemic stroke at a single tertiary hospital, 2010–2020
- Participants
- 918 patients
- Exposure
- Oral anticoagulation (OAC) alone vs antiplatelet (APT) alone vs OAC/APT after stroke
- Outcome
- Net clinical outcome:
- Recurrent stroke
- Any bleeding
- Hospitalization or ED visits for cardiovascular (CV) events
- Death
- Follow-up
- Median 2.1 years
Main finding
Net clinical outcome
Adjusted hazard ratio
1.47
95% CI 1.08–2.00
P = 0.015
APT vs OAC
adjusted HR 1.47 (95% CI 1.08–2.00); P = 0.015
As reported in the abstract
- Overall incidence rate of net clinical outcome (NCO) per 100 patient-year (PY)
- 20.14
Observational data: associations, not effects.
Further findings
| Outcome | fold higher risk | P value |
|---|---|---|
| Recurrent stroke (OAC/APT(s) vs OAC alone) · median follow-up 2.1 years · marginally higher risk of any bleeding | 1.62 | P = 0.040 |
Antithrombotic prescription
- OAC during admission
- 33.4%
- APT(s) during admission
- 11.1%
- OAC and APT(s) during admission
- 53.4%
- OAC at first outpatient visit
- 67.0%
- APT(s) at first outpatient visit
- 9.1%
- OAC and APT(s) at first outpatient visit
- 21.7%
- Non-prescription of OAC post-stroke
- 11.3%
- mostly continued up to one year after ischaemic stroke (IS)
Aetiology of IS
- Cardioembolism
- 71.2%
- Undetermined aetiology
- 19.8%
- Large artery atherosclerosis
- 6.0%
- AF and IS diagnosed simultaneously
- 33.9%
Overall NCO incidence rate · median follow-up 2.1 years
- NCO per 100 patient-year
- 20.14
Safety
Any bleeding
- Marginally higher risk with OAC/APT(s) than OAC monotherapy
Original publication
Association between antithrombotic therapy after stroke in patients with atrial fibrillation and the risk of net clinical outcome: an observational cohort study. Europace. Published 30 January 2024. doi:10.1093/europace/euae033
Summarised from the published abstract; every number is checked against it