Temporal Patterns Of Antithrombotic Therapy And Clinical Outcomes After Atrial Fibrillation-Related Stroke: A Multicenter Prospective Cohort Study

초록

Background and Aims: The optimal timing and strategy for antithrombotic therapy in patients with acute ischemic stroke and atrial fibrillation (AF) remain unclear in the NOAC era. We aimed to describe real-world antithrombotic treatment patterns and associated outcomes over time following AF-related stroke. Methods: We conducted a prospective cohort study of 2,965 patients with acute ischemic stroke and AF, enrolled from 16 tertiary stroke centers in South Korea between February 2018 and January 2021. Patients were followed through January 2022. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause death. Secondary outcomes included individual components and major bleeding events. Results: During a median follow-up of 1.92 years, early-phase antithrombotic strategies varied: 50.9% received antiplatelet-only therapy within 48 hours, 23.2% received NOAC monotherapy, and 10.4% received combination therapy. By discharge, 65.7% of patients were on NOAC monotherapy, a trend that remained stable over time. The incidence of the primary outcome was highest in the first two weeks (32.7 per 100 person-months) and declined thereafter. Across all periods, NOAC monotherapy was associated with lower event rates (3-month rate: 4.95 per 100 person-months) than antiplatelet-only (11.98) or no therapy (18.44). Conclusions: Antithrombotic treatment in AF-related stroke showed substantial early heterogeneity, but shifted toward NOAC monotherapy by discharge. This strategy was linked to better outcomes, particularly during the early high-risk period. These findings highlight the need for time-sensitive, individualized treatment approaches in this population.