PMID- 32472251
OWN - NLM
STAT- MEDLINE
DCOM- 20211022
LR  - 20211022
IS  - 1868-601X (Electronic)
IS  - 1868-4483 (Linking)
VI  - 11
IP  - 6
DP  - 2020 Dec
TI  - Effectiveness of Adding Antiplatelets to Oral Anticoagulants in Patients with 
      Acute Ischemic Stroke with Atrial Fibrillation and Concomitant Large Artery 
      Steno-Occlusion.
PG  - 1322-1331
LID - 10.1007/s12975-020-00822-z [doi]
AB  - We investigated the effectiveness of adding antiplatelet (AP) to oral 
      anticoagulant (OAC) treatment versus OAC treatment alone in patients with AIS 
      with atrial fibrillation (AF) and significant large artery steno-occlusion 
      (LASO). This study is a retrospective analysis of a nationwide, prospective, 
      multicenter stroke registry between April 2008 and November 2017. Patients with 
      acute (within 48 h of onset) and mild-to-moderate (NIHSS score </= 15) stroke with 
      AF and concomitant LASO were identified. Antithrombotic regimens at discharge 
      were categorized into OAC alone or OAC + AP. The primary outcome event was a 
      composite of recurrent stroke, myocardial infarction, and all-cause mortality 
      within 3 months of stroke. Among the 2553 patients (age, 73 +/- 10 years; men, 
      50.4%), 78.8% were treated with OAC alone, and 21.2% were treated with OAC + AP. 
      The primary outcome events were significantly more common in the OAC + AP group 
      (6.7%) than the OAC alone group (4.3%) (p = 0.02). Weighted Cox proportional 
      hazard analysis showed that OAC + AP increased the risk of 3-month primary 
      outcome events compared with OAC alone (HR, 1.62 [1.06 to 2.46]). A potential 
      interaction between the type of LASO and discharge antithrombotics was suggested 
      (P(interaction) = 0.04); unlike in patients with complete occlusion (OAC + AP; 
      HR, 2.00 [1.27-3.15]), OAC + AP was comparable with OAC alone for 3-month primary 
      outcome in patients with moderate-to-severe stenosis (HR, 0.54 [0.17-1.70]). In 
      conclusion, OAC + AP might increase the risk of 3-month outcome events compared 
      with OAC alone in patients with AIS with AF and concomitant LASO. However, the 
      effect of additional AP to OAC might differ according to LASO type.
FAU - Kim, Joon-Tae
AU  - Kim JT
AUID- ORCID: 0000-0003-4028-8339
AD  - Department of Neurology, Chonnam National University Hospital, Gwangju, South 
      Korea. alldelight2@jnu.ac.kr.
FAU - Lee, Ji Sung
AU  - Lee JS
AD  - Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Kim, Beom Joon
AU  - Kim BJ
AD  - Department of Neurology, Seoul National University College of Medicine, 
      Cerebrovascular Center, Seoul National University Bundang Hospital, 82, Gumi-ro 
      173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
FAU - Park, Jong-Moo
AU  - Park JM
AD  - Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, 
      South Korea.
FAU - Kang, Kyusik
AU  - Kang K
AD  - Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, 
      South Korea.
FAU - Lee, Soo Joo
AU  - Lee SJ
AD  - Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, 
      South Korea.
FAU - Kim, Jae Guk
AU  - Kim JG
AD  - Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, 
      South Korea.
FAU - Cha, Jae-Kwan
AU  - Cha JK
AD  - Department of Neurology, Dong-A University Hospital, Busan, South Korea.
FAU - Kim, Dae-Hyun
AU  - Kim DH
AD  - Department of Neurology, Dong-A University Hospital, Busan, South Korea.
FAU - Park, Tai Hwan
AU  - Park TH
AD  - Department of Neurology, Seoul Medical Center, Seoul, South Korea.
FAU - Park, Sang-Soon
AU  - Park SS
AD  - Department of Neurology, Seoul Medical Center, Seoul, South Korea.
FAU - Lee, Kyung Bok
AU  - Lee KB
AD  - Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea.
FAU - Lee, Jun
AU  - Lee J
AD  - Department of Neurology, Yeungnam University Hospital, Daegu, South Korea.
FAU - Hong, Keun-Sik
AU  - Hong KS
AD  - Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South 
      Korea.
FAU - Cho, Yong-Jin
AU  - Cho YJ
AD  - Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South 
      Korea.
FAU - Park, Hong-Kyun
AU  - Park HK
AD  - Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South 
      Korea.
FAU - Lee, Byung-Chul
AU  - Lee BC
AD  - Department of Neurology, Hallym Neurological Institute, Hallym University Sacred 
      Heart Hospital, Anyang, South Korea.
FAU - Yu, Kyung-Ho
AU  - Yu KH
AD  - Department of Neurology, Hallym Neurological Institute, Hallym University Sacred 
      Heart Hospital, Anyang, South Korea.
FAU - Oh, Mi Sun
AU  - Oh MS
AD  - Department of Neurology, Hallym Neurological Institute, Hallym University Sacred 
      Heart Hospital, Anyang, South Korea.
FAU - Kim, Dong-Eog
AU  - Kim DE
AD  - Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea.
FAU - Ryu, Wi-Sun
AU  - Ryu WS
AD  - Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea.
FAU - Choi, Jay Chol
AU  - Choi JC
AD  - Department of Neurology, Jeju National University Hospital, Jeju National 
      University School of Medicine, Jeju, South Korea.
FAU - Kwon, Jee-Hyun
AU  - Kwon JH
AD  - Department of Neurology, Ulsan University College of Medicine, Ulsan, South 
      Korea.
FAU - Kim, Wook-Joo
AU  - Kim WJ
AD  - Department of Neurology, Ulsan University College of Medicine, Ulsan, South 
      Korea.
FAU - Shin, Dong-Ick
AU  - Shin DI
AD  - Department of Neurology, Chungbuk National University Hospital, Cheongju, South 
      Korea.
FAU - Sohn, Sung Il
AU  - Sohn SI
AD  - Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South 
      Korea.
FAU - Hong, Jeong-Ho
AU  - Hong JH
AD  - Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South 
      Korea.
FAU - Park, Man-Seok
AU  - Park MS
AD  - Department of Neurology, Chonnam National University Hospital, Gwangju, South 
      Korea.
FAU - Choi, Kang-Ho
AU  - Choi KH
AD  - Department of Neurology, Chonnam National University Hospital, Gwangju, South 
      Korea.
FAU - Cho, Ki-Hyun
AU  - Cho KH
AD  - Department of Neurology, Chonnam National University Hospital, Gwangju, South 
      Korea.
FAU - Lee, Juneyoung
AU  - Lee J
AD  - Department of Biostatistics, Korea University College of Medicine, Seoul, South 
      Korea.
FAU - Gorelick, Philip B
AU  - Gorelick PB
AD  - Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, 
      USA.
AD  - Department of Translational Neuroscience, Michigan State University College of 
      Human Medicine, Grand Rapids, MI, USA.
FAU - Bae, Hee-Joon
AU  - Bae HJ
AD  - Department of Neurology, Seoul National University College of Medicine, 
      Cerebrovascular Center, Seoul National University Bundang Hospital, 82, Gumi-ro 
      173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea. 
      braindoc@snu.ac.kr.
LA  - eng
GR  - 2017ER620101#/Research of Korea Centers for Disease Control and 
      Prevention/International
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20200529
PL  - United States
TA  - Transl Stroke Res
JT  - Translational stroke research
JID - 101517297
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Administration, Oral
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage
MH  - Atrial Fibrillation/diagnosis/*drug therapy/epidemiology
MH  - Brain Ischemia/diagnosis/*drug therapy/epidemiology
MH  - Drug Therapy, Combination
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Ischemic Stroke/diagnosis/*drug therapy/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*administration & dosage
MH  - Prospective Studies
MH  - Registries
MH  - Republic of Korea/epidemiology
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Antiplatelet
OT  - Atrial fibrillation
OT  - Large artery steno-occlusion
OT  - Oral anticoagulant
OT  - Stroke
EDAT- 2020/05/31 06:00
MHDA- 2023/02/25 06:00
CRDT- 2020/05/31 06:00
PHST- 2020/01/30 00:00 [received]
PHST- 2020/05/13 00:00 [accepted]
PHST- 2020/05/10 00:00 [revised]
PHST- 2020/05/31 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2020/05/31 06:00 [entrez]
AID - 10.1007/s12975-020-00822-z [pii]
AID - 10.1007/s12975-020-00822-z [doi]
PST - ppublish
SO  - Transl Stroke Res. 2020 Dec;11(6):1322-1331. doi: 10.1007/s12975-020-00822-z. 
      Epub 2020 May 29.