Journal of the American Heart Association
October 16, 2026 · via Europe PMC
Antithrombotic Therapy for Secondary Stroke Prevention in Patients With Symptomatic Large-Artery Atherosclerosis and Atrial Fibrillation: A Multicenter Experience.
Mohamed GA, de Havenon A, Martin RH, +7 more, Turan TN
AI summary — for doctors, generated from the abstract only
In real-world patients with AF and symptomatic large-artery atherosclerotic stroke, regimens varied widely and combining an anticoagulant with an antiplatelet was linked to lower short-term stroke or death.
What was studied
A retrospective multicenter study of 191 patients at four US comprehensive stroke centers, grouped by discharge antithrombotic regimen, with recurrent stroke, symptomatic hemorrhage and death at 90 days and 1 year.
Key findings
- Anticoagulant plus antiplatelet was the most common discharge regimen (33%), and triple therapy was uncommon (4%)
- 21 patients (11%) had recurrent ischemic stroke and 26 (14%) symptomatic hemorrhage
- 90-day stroke/death was 24% with single anticoagulant versus 8% with anticoagulant plus antiplatelet, while symptomatic hemorrhage was 0% versus 12%
- At 1 year, stroke/death was 27.3% with antiplatelet alone, 11.1% with combination, 4.5% with anticoagulant alone and 0% with dual antiplatelet therapy
Clinical relevance
This highlights the uncertainty in this high-risk group and the trade-off between ischemic protection and bleeding.
Who should care
Limitations
The study is retrospective and descriptive, with small subgroups and likely confounding by indication. Median follow-up was short (68 days), so the comparisons between regimens are unadjusted and imprecise.
Management varies and outcomes are poor, so prospective trials are needed.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
Optimal antithrombotic therapy for ischemic stroke due to symptomatic large-artery atherosclerosis in patients with atrial fibrillation remains uncertain. We describe real-world prescribing patterns and outcomes across antithrombotic regimens.
METHODS
We retrospectively analyzed consecutive patients with atrial fibrillation and ischemic stroke related to symptomatic large-artery atherosclerosis (intracranial or extracranial or both) at 4 US comprehensive stroke centers. Patients were grouped by discharge regimen: single anticoagulant, single antiplatelet (sAP), single anticoagulant+sAP, dual antiplatelet therapy, or triple therapy (single anticoagulant+dual antiplatelet therapy). Outcomes were recurrent ischemic stroke, symptomatic hemorrhage, and death at 90 days and 1 year.
RESULTS
Among 191 patients (median age 75 years [interquartile range [IQR], 68-83]; 40% women; 36% prior stroke/transient ischemic attack), single anticoagulant+sAP was the most common discharge regimen (33%), followed by single anticoagulant (25%), whereas triple therapy was uncommon (4%). More than half of patients switched regimens within 1 year, mostly as the planned duration ended (71%) or following an outcome event (12%). During follow-up (median 68 days [IQR, 28-120]), 21 patients (11%) had recurrent ischemic stroke, and 26 (14%) had symptomatic hemorrhage, over half of each within 90 days; 25% of deaths occurred within 90 days. Ninety-day stroke/death rate was 24%, with single anticoagulant versus 8% with single anticoagulant+sAP; symptomatic hemorrhage rate was 0% and 12%, respectively. At 1 year, stroke/death was 27.3% with sAP, 11.1% with single anticoagulant+sAP, 4.5% with single anticoagulant, and 0% with dual antiplatelet therapy. Symptomatic hemorrhage was similar across groups.
CONCLUSIONS
In patients with atrial fibrillation and symptomatic large-artery atherosclerosis, recurrent ischemic events and mortality were common, and antithrombotic management varied substantially. The combination of single anticoagulant+sAP was associated with lower observed short-term stroke/death than single anticoagulant; however, bleeding remains a concern with prolonged therapy. Prospective studies are needed to define optimal regimen and duration for this high-risk population.
DOI
10.1161/JAHA.126.050008
PMID
42885803
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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