https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/21 Sun, 05 Apr 2026 15:18:52 GMT 2026-04-05T15:18:52Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/79442 Title: Timing of Initiation and Efficacy of Dual Antiplatelet Therapy in Minor Stroke or High-Risk TIA Authors: Shin, Jaemin; Lee, Keon Joo; Kim, Chi Kyung; Oh, Kyung mi; Kim, Do Yeon; Kim, Beom Joon; Han, Moon-Ku; Kim, Hyunsoo; Kim, Joon-Tae; Choi, Kang-Ho; Shin, Dong-Ick; Yum, Kyu Sun; Cha, Jae-Kwan; Kim, Dae-Hyun; Kim, Dong-Eog; Gwak, Dong-Seok; Park, Jong-Moo; Lee, Dongwhane; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Yu, Kyung-Ho; Oh, Mi Sun; Lee, Minwoo; Hong, Keun-Sik; Cho, Yong-Jin; Park, Hong-Kyun; Choi, Jay Chol; Kim, Joong-Goo; Park, Tai Hwan; Park, Sang-Soon; Kwon, Jee-Hyun; Kim, Wook-Joo; Lee, Jun; Kwon, Doo Hyuk; Sohn, Sung-Il; Hong, Jeong-Ho; Park, Hyungjong; Lee, Kyungbok; Lee, Jeong-Yoon; Park, Kwang-Yeol; Jeong, Hae-Bong; Kim, Chulho; Lee, Sang-Hwa; Heo, Sung Hyuk; Woo, Ho Geol; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee-Joon Abstract: BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended within 24 hours for patients with minor ischemic stroke or high-risk transient ischemic attack. However, the optimal timing for initiating DAPT remains unclear. METHODS: From a prospective multicenter cohort involving 20 stroke centers between January 2011 and April 2023, patients with minor noncardioembolic ischemic stroke (National Institutes of Health Stroke Scale score <= 5) or high-risk transient ischemic attack who presented within 7 days of symptom onset were included. We evaluated outcomes based on in-hospital initiation of DAPT versus monotherapy (aspirin or clopidogrel alone). The primary outcome was a composite of recurrent stroke, myocardial infarction, and death within 90 days. Patients were grouped by time from symptom onset to hospital arrival: 0 to 24 hours, 24 to 72 hours, and >72 hours. Time-to-treatment effects were analyzed using Cox proportional hazards models, with inverse probability of treatment weighting based on propensity scores. The adjusted models incorporated demographic factors, baseline clinical characteristics, vascular risk factors, stroke subtype, relevant arterial status, and prior antiplatelet use. RESULTS: Among the 41 530 patients (mean age, 66.3 years; 25 771 [62%] male), 25 112 (60.5%) received DAPT. The 90-day primary outcome occurred in 2663 (10.7%) of the DAPT group versus 1900 (11.6%) in the monotherapy group (hazard ratio, 0.82 [95% CI, 0.77-0.87]). The benefit of DAPT was most pronounced when initiated within 24 hours (hazard ratio, 0.74 [95% CI, 0.69-0.79]). No significant benefit was observed when DAPT was initiated between 24 and 72 hours (hazard ratio, 1.00 [95% CI, 0.88-1.15]), and a higher risk was suggested for initiation beyond 72 hours (hazard ratio, 1.25 [95% CI, 1.01-1.55]). Time-dependent analysis showed a benefit crossing the null at approximate to 42 hours. CONCLUSIONS: Early initiation of DAPT was associated with the greatest clinical benefit, consistent with current guideline recommendations. The therapeutic effect appeared to decline progressively beyond this period, with an estimated threshold around 42 hours. Sun, 01 Mar 2026 00:00:00 GMT https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/79442 2026-03-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/79541 Title: Annual Trends in Risk Factor Control Status at the Time of Ischemic Stroke in South Korea Authors: Kim, Joon-Tae; Lee, Ji Sung; Kim, Hyunsoo; Kim, Beom Joon; Kang, Jihoon; Lee, Keon-Joo; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Park, Tai Hwan; Lee, Kyungbok; Lee, Jeong-Yoon; Lee, Jun; Kwon, Doo Hyuk; Hong, Keun-Sik; Cho, Yong-Jin; Park, Hong-Kyun; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi Sun; Lee, Minwoo; Kim, Dong-Eog; Gwak, Dong-seok; Choi, Jay Chol; Kwon, Jee-Hyun; Kim, Wook-Joo; Shin, Dong-Ick; Yum, Kyu Sun; Sohn, Sung Il; Hong, Jeong-Ho; Park, Hyungjong; Lee, Sang-Hwa; Kim, Chulho; Park, Man-Seok; Ryu, Wi-Sun; Park, Kwang-Yeol; Heo, Sung Hyuk; Lee, Juneyoung; Saver, Jeffrey L.; Bae, Hee-Joon Abstract: Background: This study aimed to evaluate secular trends in the control of major risk factors at the time of ischemic stroke to assess the real-world implementation of prevention guidelines and identify areas needing greater clinical attention for improved early stroke outcomes. Methods: We retrospectively analyzed data from a prospective, multicenter, nationwide registry of consecutive patients with acute ischemic stroke between 2011 and 2022. For risk factor controls of interest, hypertension, diabetes, dyslipidemia, and atrial fibrillation (AF) were considered. Well-controlled risk factors were defined as follows: "well-controlled hypertension": hypertension with prior antihypertensive medication and systolic blood pressure <140 mm Hg on admission; "well-controlled diabetes": prior antidiabetic medication with glycated hemoglobin <7.0%; "well-controlled dyslipidemia": prior statin therapy with low-density lipoprotein cholesterol <100 mg/dL; and "well-controlled AF": presence of AF with prior oral anticoagulant use. Linear trends in control rates were tested via the Cochran-Armitage and linear contrast tests. Results: Among 76 962 patients (68.8 +/- 13.3 years;men, 59.0%), the adjusted rate of well-controlled hypertension decreased from 35.7% (95% CI, 34.0%-37.5%) in 2011 to 25.5% (95% CI, 24.4%-26.7%) in 2022, whereas well-controlled status improved for diabetes (26.4%-29.4%), dyslipidemia (22.2%-48.6%), and AF (26.0%-55.7%) from 2011 to 2022 (P-trend<0.001). The rates of well-controlled risk factors were relatively higher in patients with a history of stroke than in those with no history of stroke, except for hypertension. The 3-month composite of stroke, myocardial infarction, and all-cause death significantly declined from 10.0% in 2011 to 8.6% in 2022 (P-trend<0.001). Conclusions: Our study confirmed a continuous increase in prestroke risk factor control, including diabetes, dyslipidemia, and AF, but the rate remained suboptimal at stroke onset. These findings may help inform strategies to improve risk factor management by identifying priority areas that warrant targeted intervention in clinical practice and population-level guidelines. Sun, 01 Mar 2026 00:00:00 GMT https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/79541 2026-03-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/79540 Title: Temporal Patterns of Antithrombotic Therapy and Clinical Outcomes After Atrial Fibrillation-Related Stroke Authors: Lee, Keon-Joo; Oh, Hoonji; Jeong, Han-Gil; Kim, Beom Joon; Han, Moon-Ku; Kim, Joon-Tae; Choi, Kang-Ho; Shin, Dong-Ick; Cha, Jae-Kwan; Kim, Dae-Hyun; Kim, Dong-Eog; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Oh, Mi-Sun; Yu, Kyung-Ho; Lee, Byung-Chul; Hong, Keun-Sik; Cho, Yong-Jin; Choi, Jay Chol; Park, Tai Hwan; Lee, Kyungbok; Kwon, Jee-Hyun; Kim, Wook-Joo; Lee, Jun; Lee, Ji Sung; Hong, Da Young; Lee, Juneyoung; Gorelick, Philip B.; Bae, Hee-Joon; LEE, KYU BONG(CRCS-K investigators) Abstract: 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. Sun, 01 Mar 2026 00:00:00 GMT https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/79540 2026-03-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/79386 Title: Management Strategies for Early Neurological Deterioration in Noncardioembolic Ischemic Stroke Authors: Kim, Hyunsoo; Kim, Joon-Tae; Lee, Ji Sung; Kim, Beom Joon; Kang, Jihoon; Kim, Do Yeon; Lee, Keon Joo; Kim, Chi Kyung; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Park, Tai Hwan; Lee, Jeong-Yoon; Lee, Kyungbok; Lee, Jun; Kwon, Doo Hyuk; Hong, Keun-Sik; Cho, Yong-Jin; Park, Hong-Kyun; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi Sun; Lee, Minwoo; Kim, Dong-Eog; Gwak, Dong-Seok; Choi, Jay Chol; Kang, Chul-Hoo; Kwon, Jee-Hyun; Kim, Wook-Joo; Shin, Dong-Ick; Yum, Kyu Sun; Sohn, Sung Il; Hong, Jeong-Ho; Lee, Sang-Hwa; Kim, Chulho; Choi, Kang-Ho; Park, Man-Seok; Park, Kwang-Yeol; Jeong, Hae-Bong; Lee, Juneyoung; Bae, Hee-Joon Abstract: BACKGROUND: Early neurological deterioration (END) is a frequent complication of acute ischemic stroke. Although END worsens clinical outcomes, standardized treatment strategies remain undefined, resulting in variability in clinical practice. This study examines real-world treatment patterns for END and compares the effects of different strategies on neurological and functional outcomes. METHODS: This study analyzed data from a nationwide, prospective, multicenter stroke registry in South Korea, including patients with noncardioembolic stroke who developed END due to stroke progression between January 2019 and August 2024. END was defined as new or worsening neurological symptoms meeting National Institutes of Health Stroke Scale criteria (>= 2-point total or >= 1 point in consciousness or motor subscores) with radiological confirmation. Patients were classified into conservative management, antithrombotics change, and induced hypertension (iHTN). The primary outcomes were neurological improvement, defined as a >= 2-point reduction in the National Institutes of Health Stroke Scale score, and 3-month functional outcome measured by modified Rankin Scale ordinal shift. Secondary outcomes included good functional recovery (modified Rankin Scale score, 0-2) and composite vascular events (death, stroke, and myocardial infarction). Multivariable analyses adjusted for age, sex, prestroke modified Rankin Scale, initial National Institutes of Health Stroke Scale score, vascular risk factors, the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification, acute thrombolysis, and laboratory covariates. RESULTS: Among 3067 patients with END due to stroke progression, 1840 (60.0%) received conservative management, 747 (24.4%) underwent antithrombotic changes, and 480 (15.7%) were treated with iHTN. Neurological improvement occurred in 34.2% of patients, with the highest in the iHTN group (41.5%) compared with the conservative (32.2%) and antithrombotics change groups (34.4%; P<0.001). In adjusted analyses, iHTN increased the odds of neurological improvement (adjusted odds ratio, 1.55 [95% CI, 1.25-1.92]) and a favorable 3-month modified Rankin Scale shift (adjusted odds ratio, 1.24 95% CI, 1.03-1.48]) compared with conservative management, particularly in patients with large artery atherosclerosis. Antithrombotics change showed no significant association with neurological or functional recovery. CONCLUSIONS: In patients with noncardioembolic ischemic stroke who developed END due to stroke progression, iHTN was associated with favorable clinical outcomes. Sun, 01 Feb 2026 00:00:00 GMT https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/79386 2026-02-01T00:00:00Z