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Antithrombotic therapy after acute ischaemic stroke in patients with AF

Contrary to current guidelines, 30% of patients with atrial fibrillation (AF) and recent ischaemic stroke (IS) are not prescribed any oral anticoagulation (OAC) therapy on discharge, whereas a further 30% are prescribed combination OAC and antiplatelet therapy, according to a study published recently in Stroke.1

A prospective cohort of consecutive patients included in the Ontario Stroke Registry was examined. Multivariable Cox proportional hazard models were used to determine the association between antithrombotic regimen on discharge and time to death or admission for recurrent IS, myocardial infarction, or major bleeding.

2,162 patients were hospitalised for AF and acute IS. At discharge, 8.0% were prescribed no antithrombotic therapy, 21.6% antiplatelet therapy alone, 39.3% OAC (warfarin) alone, and 31.1% combination OAC and antiplatelet therapy.

Compared with OAC alone (hazard ratio [HR], 1.0), no antithrombotic therapy (HR, 1.51; 95% confidence interval, 1.23–1.86) and antiplatelet therapy (HR, 1.31; 95% confidence interval, 1.14–1.50) were associated with an increased risk of the primary composite outcome, whereas combination OAC and antiplatelet therapy was associated with a trend toward a reduced risk (HR, 0.91; 95% confidence interval, 0.80–1.04 overall and HR, 0.79; 95% confidence interval, 0.61–1.02 in those with coronary heart disease).

Results were consistent in those with severe stroke: HR 1.58 (95% CI, 1.21–2.06), 1.34 (95% CI, 1.09–1.63), and 0.91 (95% CI, 0.74–1.11), respectively. Combination OAC and antiplatelet therapy in patients at high cardiovascular risk requires evaluation in clinical trials, particularly with the newer OACs, given their more favourable risk–benefit ratio compared with warfarin, say the authors.


1. McGrath ER, Kapral MK, Fang J, et al. Antithrombotic therapy after acute ischemic stroke in patients with atrial fibrillation. Stroke 2014.

Published on: December 19, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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