From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.).
Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain.
AJNR Am J Neuroradiol. 2022 May;43(5):727-730. doi: 10.3174/ajnr.A7482. Epub 2022 Apr 7.
Antithrombotic therapy following carotid artery stent placement with concomitant atrial fibrillation is not well-established. Our aim was to assess the safety and efficacy of the combination of direct oral anticoagulants and a P2Y12 inhibitor at 30 days after carotid artery stent placement in patients with atrial fibrillation.
We designed an observational single-center study including patients who underwent carotid artery stent placement with concomitant atrial fibrillation. We studied 3 groups according to antithrombotic therapy: 1) the direct oral anticoagulants plus clopidogrel (DC) group: receiving direct oral anticoagulants plus a P2Y12 inhibitor; 2) the triple therapy group: anticoagulation and dual antiplatelet therapy; and 3) the dual antiplatelet therapy group: following dual antiplatelet therapy alone. The safety outcome was a major or clinically relevant non-major bleeding event at the first month. The efficacy outcomes were the thromboembolic events (myocardial infarction, stroke, systemic embolism, or stent thrombosis).
Of 959 patients with carotid artery stent placement, 91 met the inclusion criteria, including 24 patients in the DC group, 42 patients in the triple therapy group, and 25 in the dual antiplatelet therapy group. The mean age was 72.27 (SD, 8.1 ) years, with similar baseline characteristics. The median CHADS-VASc score for each group was 6 (interquartile range = 5-6), 5 (interquartile range = 4-6), and 5 (interquartile range = 4-6), respectively. The median HAS-BLED score was 4 in the 3 groups (= .17). The primary safety end point was 23.8% in the triple therapy group compared with 4% in the dual antiplatelet therapy group (= .032), with no bleeding events in the DC group (= .007). There was 1 stent thrombosis in DC group and a cardioembolic stroke in the dual antiplatelet therapy group (= .41).
Among patients with carotid artery stent placement with atrial fibrillation, triple therapy confers a high bleeding risk. A regimen of direct oral anticoagulants plus a P2Y12 inhibitor might confer a good safety profile with significantly lower rates of bleeding and optimal efficacy.
颈动脉支架置入术后合并心房颤动患者的抗栓治疗尚未得到充分确立。我们的目的是评估颈动脉支架置入术后 30 天内联合使用直接口服抗凝剂和 P2Y12 抑制剂在合并心房颤动的患者中的安全性和疗效。
我们设计了一项观察性单中心研究，纳入了接受颈动脉支架置入术合并心房颤动的患者。根据抗栓治疗方案，我们将患者分为 3 组：1）直接口服抗凝剂+氯吡格雷（DC）组：接受直接口服抗凝剂+P2Y12 抑制剂；2）三联治疗组：抗凝和双联抗血小板治疗；3）双联抗血小板治疗组：单独接受双联抗血小板治疗。安全性结局为第一个月时发生的重大或临床相关非重大出血事件。有效性结局为血栓栓塞事件（心肌梗死、卒中和全身性栓塞或支架血栓形成）。
在 959 例行颈动脉支架置入术的患者中，91 例符合纳入标准，其中 DC 组 24 例，三联治疗组 42 例，双联抗血小板治疗组 25 例。平均年龄为 72.27（标准差 8.1）岁，基线特征相似。每组的平均 CHADS2-VASc 评分分别为 6（四分位距[IQR]：5-6）、5（IQR：4-6）和 5（IQR：4-6）。3 组的平均 HAS-BLED 评分均为 4（IQR：4-6）。三联治疗组的主要安全性终点为 23.8%，双联抗血小板治疗组为 4%（P=.032），DC 组无出血事件（P=.007）。DC 组有 1 例支架血栓形成，双联抗血小板治疗组有 1 例心源性卒中（P=.41）。
在接受颈动脉支架置入术合并心房颤动的患者中，三联治疗会增加出血风险。直接口服抗凝剂联合 P2Y12 抑制剂的方案可能具有良好的安全性，出血风险显著降低，疗效最佳。
