Combined antithrombotic therapy vs. oral anticoagulation alone for ischemic stroke with concomitant atrial…

Meta-analysisNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology· Aug 2026

Combined antithrombotic therapy vs. oral anticoagulation alone for ischemic stroke with concomitant atrial fibrillation and large artery atherosclerosis: a systematic review and meta-analysis.

Samuel Oliveira de Amorim, Matheus da Silva Ferreira, Cid Soares … Marcos Manoel Honorato

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Stroke & CerebrovascularMeta-analysisTreatmentQ2IF 2.2

Adding antiplatelets to anticoagulation raises major bleeding without cutting stroke recurrence

Combined antithrombotic therapy vs. oral anticoagulation alone for ischemic stroke with concomitant atrial fibrillation and large artery atherosclerosis: a systematic review and meta-analysis.

Samuel Oliveira de Amorim … Marcos Manoel Honorato

Neurological sciences · Aug 2026 · Q2 in Neurology

Background

Treating ischemic stroke patients who have both nonvalvular atrial fibrillation (nonvalvular atrial fibrillation) and large artery atherosclerosis (large artery atherosclerosis) presents a clinical challenge.

Methods

We conducted a systematic review and meta-analysis of randomized and observational studies to compare oral anticoagulation monotherapy against combined therapy (oral anticoagulation + antiplatelet therapy) in patients with recent ischemic stroke, nonvalvular atrial fibrillation, and large artery atherosclerosis.

n = 14,884 patients

Results

adding antiplatelets raised major bleeding risk

RR by subgroup · 95% CI

More results

Combined therapy was not associated with a significant reduction in recurrent ischemic stroke (RR 0.98; 95% CI: 0.92-1.04; p = 0.55) or all-cause mortality (RR 1.11; 95% CI: 0.98-1.26; p = 0.09) compared to oral anticoagulation monotherapy.

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Conclusion · 1 of 2

Our findings indicate that adding antiplatelets to anticoagulation in patients with stroke, AF, and large artery atherosclerosis confers no real clinical benefit but significantly exacerbates hemorrhagic morbidity.

Conclusion · 2 of 2

Consequently, oral anticoagulation monotherapy should remain the standard of care, while combined therapy should be avoided in routine practice.

Combined antithrombotic therapy vs. oral anticoagulation alone for ischemic stroke with concomitant atrial fibrillation and large artery atherosclerosis: a systematic review and meta-analysis.

Combined antithrombotic therapy vs. oral anticoagulation alone for ischemic stroke with concomitant atrial fibrillation and large artery atherosclerosis: a systematic review and meta-analysis.

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