Temporal Patterns of Antithrombotic Therapy and Clinical Outcomes After Atrial Fibrillation‐Related Stroke

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BACKGROUND: This study aimed to describe the temporal evolution of antithrombotic treatment strategies and associated clinical outcomes after atrial fibrillation-related acute ischemic stroke. METHODS: This multicenter prospective cohort study enrolled patients with acute ischemic stroke and atrial fibrillation from 16 tertiary stroke centers across South Korea between February 2018 and January 2021, with follow-up completed by January 2022. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause death. Secondary outcomes included individual components of the primary outcome and major bleeding events. RESULTS: The median follow-up duration was 1.92 years. Among 2965 patients (mean±SD age, 75.3 [10.2] years; 54.1% male), antithrombotic strategies varied widely in the acute phase. Within 48 hours of admission, 50.9% received antiplatelet-only therapy (29.4% single, 21.5% dual), 23.2% received non-vitamin K antagonist oral anticoagulant monotherapy, and 10.4% received a combination of antiplatelets and anticoagulants. By discharge, non-vitamin K antagonist oral anticoagulant monotherapy had become the predominant treatment strategy (65.7%), and this pattern persisted throughout follow-up. The incidence of the primary end point was highest in the first 2 weeks (32.70 [95% CI, 29.64-36.06] per 100 person-months) and declined thereafter. Across all time periods, patients receiving non-vitamin K antagonist oral anticoagulant monotherapy consistently had lower incidence rates (3-month rate, 4.95 [95% CI, 4.37-5.61] per 100 person-months) than those receiving antiplatelet-only therapy (11.98 [95% CI, 9.57-15.01]) or no antithrombotic therapy (18.44 [95% CI, 14.26-23.86]). CONCLUSIONS: In this prospective cohort of patients with atrial fibrillation-related stroke, early antithrombotic treatment strategies were heterogeneous but evolved primarily toward use of non-vitamin K antagonist oral anticoagulant monotherapy. Treatment selection was associated with marked differences in outcomes, particularly during the early high-risk period.

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