Abstract
Nonvalvular atrial fibrillation (NVAF) and carotid stenosis are important risk factors for stroke. Carotid angioplasty and stent placement (CAS) is recommended for patients with symptomatic high-grade carotid stenosis. The optimal medical management for patients with NVAF after CAS remains unclear. We aimed to clarify this issue using real-world data from the Taiwanese National Health Insurance Research Database (NHIRD). In total, 2116 consecutive NVAF patients who received CAS between January 1, 2010, and December 31, 2016, from NHIRD were divided into groups based on post-procedure medication as follows: only antiplatelet agent (OAP, n = 587); only anticoagulation agent (OAC, n = 477); dual antiplatelet agents (DAP, n = 49); and a combination of antiplatelet and anticoagulation agents (CAPAC, n = 304). Mortality, vascular events, and major bleeding episodes were compared after matching with the Charlson comorbidity index and CHA2DS2-VASc score. The CAPAC and the OAC groups had lower mortality rates than the OAP group (P = 0.0219), with no statistical differences in major bleeding, ischemic stroke, or vascular events. Conclusively, OAC therapy after CAS appears suitable for NVAF patients. CAPAC therapy might be considered as initial therapy or when there is concern about vascular events.
Highlights
Nonvalvular atrial fibrillation (NVAF) is the most common risk factor for cardiogenic stroke, with a global prevalence of approximately 1–2%1
There was a higher proportion of comorbidities like DM, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) in the only antiplatelet agent (OAP) group patients
The final analysis was based on cross-comparison after matching between groups except the DAP group because there were not enough patients who took dual antiplatelet agents consistently after carotid angioplasty and stent placement (CAS) to match with other groups
Summary
Nonvalvular atrial fibrillation (NVAF) is the most common risk factor for cardiogenic stroke, with a global prevalence of approximately 1–2%1. Patients with severe carotid atherosclerosis have a high risk of coronary heart disease and sudden death[11]. Antiplatelet agents such as aspirin and P2Y12 inhibitors that inhibit platelet aggregation are the best choice for carotid atherosclerosis. Antiplatelet and anticoagulation agents seem necessary for patients with AF and severe carotid stenosis after vascular intervention. A combination of anticoagulation and dual antiplatelet agents appears to be a reasonable choice; there are concerns about a high bleeding r isk[18]. We aimed to conduct a preliminary evaluation of the effects of different medical therapies for this situation in real-world data
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