Introduction

We evaluated the effect of prior antiplatelet therapy on large vessel occlusion (LVO) in patients with non-valvular atrial fibrillation (NVAF) newly initiated on apixaban.

Methods

Patients with acute LVO with acute stroke due to NVAF or stenosis with NVAF started on apixaban within 14 days of onset were enrolled. We compared incidence of major bleeding, cerebral hemorrhage, ischemic events, cerebral infarction, and all-cause mortality between patients with and without prior antiplatelet therapy for acute LVO. We also compared these events between patients who continued antiplatelet therapy after onset (continued group) and those who discontinued it (discontinued group). Hazard ratios were estimated after adjusting for confounders; interaction was evaluated considering intravenous thrombolysis (IVT) or endovascular treatment (EVT) according to major bleeding.

Results

The study comprised 686 eligible patients (excluded [n = 194]; enrolled [n = 492]). The antiplatelet group consisted of older patients (mean: 79 vs. 76 years; p = 0.006) and had a higher cumulative incidence of major bleeding (7.3% vs. 2.9%, p = 0.003). The incidence of ischemic events and all-cause mortality was similar between the groups. Among the 109 patients in the antiplatelet group, the cumulative incidence of major bleeding, ischemic events, and all-cause mortality was comparable between continued group (n = 26) and discontinued group (n = 83). There were no significant differences between groups with and without IVT/EVT. However, major bleeding occured more frequently in the antiplatelet group without IVT.

Conclusion

Prior antiplatelet therapy for LVO in patients with NVAF newly initiated on apixaban was associated with major bleeding, which was more frequent in the antiplatelet group without IVT.

中文翻译：

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既往抗血小板治疗对新开始使用阿哌沙班的非瓣膜性房颤患者大血管闭塞的影响

介绍

我们评估了先前抗血小板治疗对新开始使用阿哌沙班的非瓣膜性心房颤动 (NVAF) 患者大血管闭塞 (LVO) 的影响。

方法

纳入因 NVAF 引起的急性中风的急性 LVO 或因 NVAF 狭窄而在发病 14 天内开始使用阿哌沙班的患者。我们比较了既往接受过抗血小板治疗的急性 LVO 患者与未接受过抗血小板治疗的患者的大出血、脑出血、缺血性事件、脑梗塞和全因死亡率的发生率。我们还比较了发病后继续抗血小板治疗的患者（继续组）和停止抗血小板治疗的患者（停止组）之间的这些事件。调整混杂因素后估计风险比；根据大出血，考虑静脉溶栓（IVT）或血管内治疗（EVT）评估相互作用。

结果

该研究包括 686 名符合条件的患者（排除 [ n  = 194]；入组 [ n  = 492]）。抗血小板组由老年患者组成（平均：79 岁与76 岁；p  = 0.006），并且大出血的累积发生率较高（7.3%与2.9%，p  = 0.003）。两组间缺血事件的发生率和全因死亡率相似。在抗血小板治疗组的 109 名患者中，大出血、缺血性事件和全因死亡率的累积发生率在继续治疗组 ( n  = 26) 和停药组 ( n = 83）。有和没有 IVT/EVT 的组之间没有显着差异。然而，在没有 IVT 的抗血小板组中，大出血发生的频率更高。

结论

新近开始使用阿哌沙班的 NVAF 患者既往接受过 LVO 抗血小板治疗与大出血有关，在没有 IVT 的抗血小板组中更常见。