Causes of Ischemic Stroke in Patients with Atrial Fibrillation

Dinç, Yasemin; Bakar, Mustafa; Hakyemez, Bahattin

doi:10.4274/tnd.2020.60820

Cited by 3 publications

(7 citation statements)

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“…Although OAC significantly reduce the thromboembolic risk in patients with AF, the optimal treatment regimen in patients with two or more causes (AF and significant stenosis in the parent artery) remains unclear. 5,6,9,36 The combination of OAC and antiplatelet agents can be an option. In patients with AF who require percutaneous coronary interventions due to acute coronary syndrome, a combination of antiplatelet therapy using a P2Y12 inhibitor and an OAC showed a non-inferior ischemic event with fewer bleeding complications than did triple antithrombotic therapy (dual antiplatelet therapy plus OAC).…”

Section: Discussionmentioning

confidence: 99%

“…This may explain why patients were treated with combination regimens; antiplatelet agents are generally considered to treat atherosclerotic diseases. 6,9,16,38 Therefore, we attempted to minimize the confounding factors from the imbalance of the baseline characteristics using PS matching with IPTW. After balancing all variables, only the OAC group showed a beneficial effect on the 1-year composite outcome and death.…”

Section: Discussionmentioning

confidence: 99%

“…Atrial fibrillation (AF) accounts for two-thirds of all cases of cardioembolic stroke; long-term oral anticoagulants (OAC) are usually recommended to reduce the recurrence of embolic events in patients with AF. [1][2][3][4][5][6] Furthermore, onethird of the patients with ischemic stroke and AF may have concomitant large artery atherosclerosis (LAA) or smallvessel occlusion. [4][5][6][7][8][9] In such patients, simultaneous treatment with OAC and antiplatelet agents might be considered, though this is not strongly supported due to a lack of randomized clinical trials.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Furthermore, onethird of the patients with ischemic stroke and AF may have concomitant large artery atherosclerosis (LAA) or smallvessel occlusion. [4][5][6][7][8][9] In such patients, simultaneous treatment with OAC and antiplatelet agents might be considered, though this is not strongly supported due to a lack of randomized clinical trials. [4][5][6][7][8][9][10][11] However, combination treatment with OAC (mainly direct OAC) and antiplatelet agents (P2Y12 inhibitors and aspirin) is advised in patients with coronary artery disease (CAD) and AF, despite the increased risk of bleeding complications.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8][9] In such patients, simultaneous treatment with OAC and antiplatelet agents might be considered, though this is not strongly supported due to a lack of randomized clinical trials. [4][5][6][7][8][9][10][11] However, combination treatment with OAC (mainly direct OAC) and antiplatelet agents (P2Y12 inhibitors and aspirin) is advised in patients with coronary artery disease (CAD) and AF, despite the increased risk of bleeding complications. 1,2,[12][13][14][15][16][17][18][19][20][21][22] Therefore, using large linked datasets, we aimed to investigate whether a combination of OAC and antithrombotic agents decreases the recurrence of ischemic stroke over 1 year in patients with ischemic stroke, AF, and LAA.…”

Section: Introductionmentioning

confidence: 99%

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Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis

Kim

Lee

Yoon

et al. 2023

International Journal of Stroke

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Background: Optimal antithrombotic regimens to prevent recurrent stroke in patients with ischemic stroke due to AF and atherosclerotic large-vessel stenosis remains unknown. Aims: This study aimed to evaluate the effect of multiple antithrombotic therapies on outcomes at 1-year after ischemic stroke due to two or more causes. Methods: Based on the linked data, we identified 862 patients with ischemic stroke due to AF and large artery atherosclerosis in the relevant arteries. These patients were categorized into three groups, according to their antithrombotic therapies at discharge after ischemic stroke: those receiving 1) antiplatelet agents, 2) oral anticoagulants (OAC), and 3) antiplatelet agents plus OAC. The study outcomes were recurrent ischemic stroke, composite outcomes, including ischemic stroke, myocardial infarction, intracerebral hemorrhage and death, and major bleeding after 1 year. Inverse probability of treatment weighting (IPTW) was used to balance the three groups using propensity scores. Results: Among 862 patients (mean age: 72.6 years, men: 58.4%), 169 (19.6%) were treated with antiplatelet agents, 405 (47.0%) were treated with OAC, and 288 (33.4%) were treated with antiplatelet agents and OAC. After applying IPTW, only OAC had a significant beneficial effect on the 1-year composite outcome (hazard ratio [HR]: 0.37, 95% confidence interval [CI]: 0.23–0.60, P < 0.001) and death (HR: 0.35, [95% CI: 0.19–0.63], P < 0.001). Patients treated with a combination of antiplatelet agents and OAC had an increased risk of major bleeding complications (HR: 5.27, [95% CI: 1.31–21.16], P = 0.019) compared with those treated with antiplatelet agents alone. However, there was no significant difference in the risk of 1-year recurrent stroke among the three groups. Conclusion: This study demonstrated that OAC monotherapy was associated with lower risks of composite outcome and death in patients at 1-year after ischemic stroke due to AF and atherosclerotic stenosis. In addition, the combination of an antiplatelet agent and OAC had a high risk of major bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis

Kim

Lee

Yoon

et al. 2023

International Journal of Stroke

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Characteristics That Affect the Long-term Clinical Outcome and Stroke Recurrence in Ischaemic Stroke Patients With Basilar Artery Atherosclerosis

dinç,

ozpar,

MESUT

et al. 2024

Preprint

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İntroduction: Posterior circulation stroke differs from anterior circulation stroke in etiopathogenesis. Studies have shown that the most common stroke aetiology in posterior circulation stroke is ischemic stroke due to large vessel atherosclerosis. However, even under aggressive medical treatment, the risk of recurrent ischemic stroke in ischemic stroke due to intracranial atherosclerotic stenosis remains high. This study aims to obtain the rate of atherosclerotic disease of the BA in our ischemic stroke population, to determine its symptomatology, and to determine the factors affecting clinical outcome and ischaemic stroke recurrence in the symptomatic group. Material method: we included 107 patients who were diagnosed with acute ischemic stroke with basilar artery stenosis. Results According to the results of our study, the degree of stenosis in atherosclerotic stenosis of the symptomatic BA was found to be an independent risk factor for stroke recurrence. Independent risk factors for unfavourable clinical outcomes in these patients were determined as female gender, stenosis being in the proximal segment, stroke mechanism being from artery to artery embolism, and congestive heart failure. Discussion The most striking result of our study is that clinical outcome was found to be closely related to the female gender, the stroke mechanism being artery-to-artery embolism, and the stenosis is in the proximal segment. If stroke mechanisms were evaluated more clearly, it would likely help provide individualized treatments.

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Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study

Topçuoğlu,

Arsava,

Özdemir

et al. 2023

tnd

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Causes of Ischemic Stroke in Patients with Atrial Fibrillation

Cited by 3 publications

References 0 publications

Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis

Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis

Characteristics That Affect the Long-term Clinical Outcome and Stroke Recurrence in Ischaemic Stroke Patients With Basilar Artery Atherosclerosis

Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study

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