(021) Aspirin and non-aspirin antiplatelet agents use and risk of ischemic and hemorrhagic stroke in patients with non-valvular atrial fibrillation with and without anticoagulant therapy: a case-referent study

Sunday, August 27, 2023

8:00 AM – 1:30 PM ADT

Location: Convention Hall

Publication Number: 1017

Presenting Author(s)

Lamiae Grimaldi, Phamacoepidemiology professor

Phamacoepidemiology professor
Clinical Research Unit AP-HP, Paris-Saclay, Hôpital Raymond Poincare, School of Medicine Simone Veil, University Versailles Saint Quentin-University Paris Saclay, INSERM (National Institute of Health and Medical Research), CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, 78180 Montigny-Le-Bretonneux, France
Paris, France

Background: Respective and joint effects of aspirin, non-aspirin antiplatelet agents (AP) and anticoagulants (AC) in primary prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) is not well documented.

Objectives: To assess the risk of all stroke, ischemic stroke and hemorrhagic stroke associated with the use of aspirin and non-aspirin AP in patients with NVAF, and to assess the effects of co-administered anticoagulants (direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA)).

Methods: Incident cases of stroke in patients with NVAF were identified within a systematic stroke registry. Referents were matched patients with NVAF and no prior history of stroke or transient ischemic attack (TIA) identified in a systematic NVAF registry. Both cases and referents had an a priori history of atherosclerosis. Stroke cases and referents were matched (1:1 ratio) on age (±5 years), sex, region of residence and date. Use of aspirin, P2Y12-inhibitors (clopidogrel, ticlopidine, ticagrelor or prasugrel), VKA or DOAC (apixaban, dabigatran, and rivaroxaban) were documented in the 30 days before index date. Multivariate conditional logistic models were applied, with adjustments on multiple cardiovascular risk factors.

Results: 676 incident stroke cases were included and matched to 676 referents. As compared to no AP use, the adjusted odds ratios (aOR) for any AP use were 0.72 [95% confidence interval (CI): 0.55-0.92], 0.64 [0.48 - 0.85] and 1.29 [0.62 - 2.68] for all, ischemic and hemorrhagic strokes, respectively. As compared to no AP use, the aOR for aspirin use and the risk of all type of stroke was 0.88 [0.67 - 1.17]; that of clopidogrel use was 0.32 [0.20-0.51]; and that of dual-AP therapy was 0.68 [0.39-1.18]. Combined AP+AC therapy was used in 22.0% of cases and 34.2% of matched referents, and had an aOR of 0.28 [0.16 - 0.51] for all stroke as compared with no AP and no AC use. AP were used alone in 28.8% of cases versus 18.6% of matched referents and were associated with an aOR of 0.63 [0.35 - 1.14] for all stroke as compared with no AP and no AC use.

Conclusions: In this case-referent study, AP use was associated with a decreased risk of ischemic stroke. A significant effect of co-administered anticoagulants was observed, reducing the risk of all type of stroke.