{
  "abstract": "BACKGROUND: Optimal antithrombotic therapy for ischemic stroke due to symptomatic large-artery atherosclerosis in patients with atrial fibrillation remains uncertain. We describe real-world prescribing patterns and outcomes across antithrombotic regimens. METHODS: We retrospectively analyzed consecutive patients with atrial fibrillation and ischemic stroke related to symptomatic large-artery 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 days and 1 year. RESULTS: Among 191 patients (median age 75 years [interquartile range [IQR], 68-83]; 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-up (median 68 days [IQR, 28-120]), 21 patients (11%) had recurrent ischemic stroke, and 26 (14%) had symptomatic hemorrhage, over half of each within 90 days; 25% of deaths occurred within 90 days. Ninety-day stroke/death rate was 24%, with single anticoagulant versus 8% with single anticoagulant+sAP; symptomatic hemorrhage rate was 0% and 12%, respectively. At 1 year, 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. CONCLUSIONS: In patients with atrial fibrillation and symptomatic large-artery 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-term 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-risk population.",
  "abstract_shown": true,
  "affiliations": [
    "Emory University Hospital",
    "Yale School of Medicine",
    "Medical University of South Carolina",
    "The University of Chicago Pritzker School of Medicine",
    "Virginia School of Medicine",
    "Mass General Hospital, Harvard Medical School",
    "Stanford School of Medicine",
    "Emory University Hospital, Emory School of Medicine"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ghada A. Mohamed",
      "orcid": "0000-0002-5045-6976"
    },
    {
      "affs": [
        1
      ],
      "name": "Adam de Havenon",
      "orcid": "0000-0001-8178-8597"
    },
    {
      "affs": [
        2
      ],
      "name": "Renee H. Martin",
      "orcid": "0000-0002-9589-681X"
    },
    {
      "affs": [
        0
      ],
      "name": "Fadi Nahab",
      "orcid": "0000-0003-1710-9881"
    },
    {
      "affs": [
        3
      ],
      "name": "Tareq Kasshout",
      "orcid": "0000-0001-7721-6465"
    },
    {
      "affs": [
        2
      ],
      "name": "Ahmad Abu Qdais",
      "orcid": "0009-0002-8616-1712"
    },
    {
      "affs": [
        4
      ],
      "name": "McKay Hanna",
      "orcid": "0000-0001-6524-2770"
    },
    {
      "affs": [
        5
      ],
      "name": "Evangelos Pavlos Myesrlis",
      "orcid": "0000-0002-7310-624X"
    },
    {
      "affs": [
        6
      ],
      "name": "Neeharika Krothapalli",
      "orcid": "0000-0002-9605-4999"
    },
    {
      "affs": [
        7
      ],
      "name": "Michael Liu"
    },
    {
      "affs": [
        2
      ],
      "name": "Tanya N. Turan",
      "orcid": "0000-0001-5399-8845"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/10yqv13vcv11v.bib",
  "cited_by": 0,
  "doi": "10.1161/jaha.126.050008",
  "fulltext_url": null,
  "id": "10yqv13vcv11v",
  "issns": [
    "2047-9980"
  ],
  "landing_url": "https://www.ahajournals.org/doi/10.1161/JAHA.126.050008",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
    ]
  ],
  "openalex": "W7222530432",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-20",
  "publisher": "Ovid Technologies (Wolters Kluwer Health)",
  "ris": "https://research.draconitic.com/paper/10yqv13vcv11v.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:28Z",
      "native_id": "10.1161/jaha.126.050008",
      "source": "crossref",
      "url": "https://www.ahajournals.org/doi/10.1161/JAHA.126.050008"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Antithrombotic Therapy for Secondary Stroke Prevention in Patients With Symptomatic Large‐Artery Atherosclerosis and Atrial Fibrillation: A Multicenter Experience",
  "title_text": "Antithrombotic Therapy for Secondary Stroke Prevention in Patients With Symptomatic Large‐Artery Atherosclerosis and Atrial Fibrillation: A Multicenter Experience",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:28Z",
  "url": "https://research.draconitic.com/paper/10yqv13vcv11v",
  "venue": "Journal of the American Heart Association",
  "versions": []
}