دورية أكاديمية
The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis-a nationwide cohort study
| العنوان: | The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis-a nationwide cohort study |
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| المؤلفون: | Tsai, Chuan-Tsai, Chan, Yi-Hsin, Liao, Jo-Nan, Chen, Tzeng-Ji, Lip, Gregory Y. H., Chen, Shih-Ann, Chao, Tze-Fan |
| المصدر: | Tsai , C-T , Chan , Y-H , Liao , J-N , Chen , T-J , Lip , G Y H , Chen , S-A & Chao , T-F 2024 , ' The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis-a nationwide cohort study ' , BMC Medicine , vol. 22 , no. 1 , 113 . https://doi.org/10.1186/s12916-024-03338-7Test |
| سنة النشر: | 2024 |
| المجموعة: | Aalborg University (AAU): Publications / Aalborg Universitet: Publikationer |
| مصطلحات موضوعية: | Administration, Oral, Anticoagulants/therapeutic use, Arteries, Atrial Fibrillation/complications, Brain Ischemia/drug therapy, Cohort Studies, Constriction, Pathologic/chemically induced, Fibrinolytic Agents/therapeutic use, Hemorrhage/chemically induced, Humans, Intracranial Hemorrhages/chemically induced, Ischemic Stroke/drug therapy, Stroke/complications, Warfarin/therapeutic use, Stroke, Warfarin, Atrial fibrillation, NOAC, Net clinical benefit |
| الوصف: | BACKGROUND: In post-stroke atrial fibrillation (AF) patients who have indications for both oral anticoagulant (OAC) and antiplatelet agent (AP), e.g., those with carotid artery stenosis, there is debate over the best antithrombotic strategy. We aimed to compare the risks of ischemic stroke, composite of ischemic stroke/major bleeding and composite of ischemic stroke/intracranial hemorrhage (ICH) between different antithrombotic strategies. METHODS: This study included post-stroke AF patients with and without extracranial artery stenosis (ECAS) (n = 6390 and 28,093, respectively) identified from the Taiwan National Health Insurance Research Database. Risks of clinical outcomes and net clinical benefit (NCB) with different antithrombotic strategies were compared to AP alone. RESULTS: The risk of recurrent ischemic stroke was higher for patients with ECAS than those without (12.72%/yr versus 10.60/yr; adjusted hazard ratio [aHR] 1.104, 95% confidence interval [CI] 1.052-1.158, p < 0.001). For patients with ECAS, when compared to AP only, non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy was associated with lower risks for ischaemic stroke (aHR 0.551, 95% CI 0.454-0.669), the composite of ischaemic stroke/major bleeding (aHR 0.626, 95% CI 0.529-0.741) and the composite of ischaemic stroke/ICH (aHR 0.577, 95% CI 0.478-0.697), with non-significant difference for major bleeding and ICH. When compared to AP only, warfarin monotherapy was associated with higher risks of major bleeding (aHR 1.521, 95% CI 1.231-1.880), ICH (aHR 2.045, 95% CI 1.329-3.148), and the composite of ischaemic stroke and major bleeding. With combination of AP plus warfarin, there was an increase in ischaemic stroke, major bleeding, and the composite outcomes, when compared to AP only. NOAC monotherapy was the only approach associated with a positive NCB, while all other options (warfarin, combination of AP-OAC) were associated with negative NCB. CONCLUSIONS: For post-stroke AF patients with ECAS, NOAC monotherapy was associated ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | English |
| العلاقة: | https://vbn.aau.dk/da/publications/b3d4113b-f52f-4918-bd04-1898c99d2bcbTest |
| DOI: | 10.1186/s12916-024-03338-7 |
| الإتاحة: | https://doi.org/10.1186/s12916-024-03338-7Test https://vbn.aau.dk/da/publications/b3d4113b-f52f-4918-bd04-1898c99d2bcbTest https://vbn.aau.dk/ws/files/697549136/Tsai_et_al._2024_._The_optimal_antithrombotic_strategy_for_post-stroke_patients_with_atrial_fibrillation_and_extracranial_artery_stenosis-a_nationwide_cohort_study.pdfTest http://www.scopus.com/inward/record.url?scp=85187501872&partnerID=8YFLogxKTest |
| حقوق: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.C747360A |
| قاعدة البيانات: | BASE |
| DOI: | 10.1186/s12916-024-03338-7 |
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