{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:38:22Z","timestamp":1792647502634,"version":"4.5.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Optimal antithrombotic therapy for ischemic stroke due to symptomatic large\u2010artery atherosclerosis in patients with atrial fibrillation remains uncertain. We describe real\u2010world prescribing patterns and outcomes across antithrombotic regimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We retrospectively analyzed consecutive patients with atrial fibrillation and ischemic stroke related to symptomatic large\u2010artery atherosclerosis (intracranial or extracranial or both) at 4 US comprehensive stroke centers. Patients were grouped by discharge regimen: single anticoagulant, single antiplatelet (sAP), single anticoagulant+sAP, dual antiplatelet therapy, or triple therapy (single anticoagulant+dual antiplatelet therapy). Outcomes were recurrent ischemic stroke, symptomatic hemorrhage, and death at 90\u2009days and 1\u2009year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 191 patients (median age 75\u2009years [interquartile range [IQR], 68\u201383]; 40% women; 36% prior stroke\/transient ischemic attack), single anticoagulant+sAP was the most common discharge regimen (33%), followed by single anticoagulant (25%), whereas triple therapy was uncommon (4%). More than half of patients switched regimens within 1 year, mostly as the planned duration ended (71%) or following an outcome event (12%). During follow\u2010up (median 68\u2009days [IQR, 28\u2013120]), 21 patients (11%) had recurrent ischemic stroke, and 26 (14%) had symptomatic hemorrhage, over half of each within 90\u2009days; 25% of deaths occurred within 90\u2009days. Ninety\u2010day stroke\/death rate was 24%, with single anticoagulant versus 8% with single anticoagulant+sAP; symptomatic hemorrhage rate was 0% and 12%, respectively. At 1\u2009year, stroke\/death was 27.3% with sAP, 11.1% with single anticoagulant+sAP, 4.5% with single anticoagulant, and 0% with dual antiplatelet therapy. Symptomatic hemorrhage was similar across groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In patients with atrial fibrillation and symptomatic large\u2010artery atherosclerosis, recurrent ischemic events and mortality were common, and antithrombotic management varied substantially. The combination of single anticoagulant+sAP was associated with lower observed short\u2010term stroke\/death than single anticoagulant; however, bleeding remains a concern with prolonged therapy. Prospective studies are needed to define optimal regimen and duration for this high\u2010risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.050008","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:26:00Z","timestamp":1792149960000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Antithrombotic Therapy for Secondary Stroke Prevention in Patients With Symptomatic Large\u2010Artery Atherosclerosis and Atrial Fibrillation: A Multicenter Experience"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5045-6976","authenticated-orcid":false,"given":"Ghada A.","family":"Mohamed","sequence":"first","affiliation":[{"name":"Emory University Hospital","place":["Atlanta, 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