Antiplatelet Agents and Oral Anticoagulant Use in Patients with Atrial Fibrillation and Carotid Artery Disease After First-Time Ischaemic Stroke.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Drugs and Therapy Pub Date : 2024-08-01 Epub Date: 2023-01-24 DOI:10.1007/s10557-023-07433-4

Stephanie L Harrison, Benjamin J R Buckley, Deirdre A Lane, Elnara Fazio-Eynullayeva, Paula Underhill, Andrew Hill, David J Werring, Gregory Y H Lip

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引用次数: 0

Abstract

Introduction: People with atrial fibrillation (AF) frequently have competing mechanisms for ischaemic stroke, including extracranial carotid atherosclerosis. The objective of this study was to determine associations between use of oral anticoagulants (OACs) plus antiplatelet agents (APA) after ischaemic stroke and outcomes for patients with AF and carotid artery disease.

Patients and methods: A retrospective cohort study was conducted. Participants receiving OACs with or without APA were propensity score-matched for age, sex, ethnicity, co-morbidities and presence of cardiac and vascular implants and grafts. Outcomes were 1-year mortality, recurrent stroke and major bleeding.

Results: Of 5708 patients, 24.1% (n=1628) received non-vitamin K antagonist OACs (NOACs) with no APA, 26.0% (n=1401) received NOACs plus APA, 20.7% (n=1243) received warfarin without APA and 29.2% (n=1436) received warfarin plus APA. There was no significant difference in risk of recurrent stroke between the groups. Compared to receiving NOACs without APA, receiving warfarin plus APA was associated with a higher risk of mortality (hazard ratio (HR) 1.51 (95% confidence interval (CI) 1.20, 1.89)) and major bleeding (HR 1.66 (95% CI 1.40, 1.96)). Receiving NOACs plus APA was also associated with a higher risk of major bleeding compared to NOACs without APA (HR 1.27 (95% CI 1.07, 1.51), respectively).

Conclusions: The results suggest for patients with AF and carotid artery disease after ischaemic stroke, receiving NOACs without APA is associated with a lower risk of major bleeding with no negative impact on recurrent stroke or mortality. Evidence from randomised trials is needed to confirm this finding.

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首次缺血性脑卒中后心房颤动和颈动脉疾病患者使用抗血小板药物和口服抗凝剂的情况。

导言：心房颤动（AF）患者经常有缺血性中风的竞争机制，包括颅外颈动脉粥样硬化。本研究旨在确定缺血性中风后使用口服抗凝药（OAC）加抗血小板药（APA）与心房颤动和颈动脉疾病患者的预后之间的关系：进行了一项回顾性队列研究。根据年龄、性别、种族、合并疾病以及是否存在心脏和血管植入物和移植物，对接受或不接受 APA 的 OACs 的参与者进行倾向评分匹配。结果为 1 年死亡率、复发性中风和大出血：在5708名患者中，24.1%（n=1628）接受了不含APA的非维生素K拮抗剂OACs（NOACs），26.0%（n=1401）接受了NOACs加APA，20.7%（n=1243）接受了不含APA的华法林，29.2%（n=1436）接受了华法林加APA。各组间的复发性中风风险无明显差异。与接受不含 APA 的 NOACs 相比，接受华法林加 APA 与更高的死亡风险（危险比 (HR) 1.51（95% 置信区间 (CI) 1.20，1.89））和大出血风险（HR 1.66（95% CI 1.40，1.96））相关。与不服用APA的NOACs相比，服用NOACs加APA也与较高的大出血风险相关（HR分别为1.27（95% CI 1.07，1.51））：结果表明，对于缺血性卒中后合并房颤和颈动脉疾病的患者，接受不含 APA 的 NOACs 与较低的大出血风险相关，但对复发卒中或死亡率无负面影响。需要随机试验的证据来证实这一发现。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.