Although low-dose direct oral anticoagulants (DOACs) are recommended for patients at high risk of bleeding complications, it remains unclear whether the dose reduction in real-world setting is also appropriate in patients after large-vessel occlusion (LVO) stroke. This study hypothesized that patients with atrial fibrillation (AF) and LVO receiving low-dose DOACs have an increased risk of ischemic and hemorrhagic events. The study aimed to assess 1 year morbidity and mortality in patients treated with standard-dose and low-dose apixaban after LVO stroke. A post hoc analysis was performed using the acute LVO registry data, which enrolled patients with AF and LVO who received apixaban within 14 days of stroke onset. The incidences of ischemic events (ischemic stroke, acute coronary syndrome, acute myocardial infarction, and systemic embolism), major bleeding events, and death from any cause were compared between patients receiving standard- and low-dose apixaban. Of 643 patients diagnosed with LVO, 307 (47.7%) received low-dose apixaban. After adjustment for clinically relevant variables, no significant differences were observed in the incidence of ischemic events (adjusted hazard ratio [aHR]: 2.12, 95% confidence interval [CI] 0.75–6.02), major bleeding events (aHR: 1.17, 95% CI 0.50–2.73), and death from any cause (aHR: 1.95, 95% CI 0.78–4.89) between patients receiving standard- and low-dose apixaban. No significant differences were observed in the incidence of ischemic events, major bleeding events, or death from any cause between patients with AF and LVO receiving standard- and low-dose apixaban.

尽管推荐对出血并发症高风险的患者使用低剂量直接口服抗凝剂（DOAC），但目前尚不清楚现实世界中的剂量减少是否也适合大血管闭塞（LVO）卒中后的患者。这项研究假设接受低剂量 DOAC 的房颤 (AF) 和 LVO 患者发生缺血和出血事件的风险增加。该研究旨在评估 LVO 卒中后接受标准剂量和低剂量阿哌沙班治疗的患者 1 年发病率和死亡率。使用急性 LVO 登记数据进行事后分析，该数据纳入了在卒中发作 14 天内接受阿哌沙班治疗的 AF 和 LVO 患者。比较接受标准剂量和低剂量阿哌沙班的患者的缺血性事件（缺血性中风、急性冠状动脉综合征、急性心肌梗死和全身性栓塞）、大出血事件和全因死亡的发生率。在 643 名诊断为 LVO 的患者中，307 名 (47.7%) 接受了低剂量阿哌沙班治疗。调整临床相关变量后，缺血事件的发生率（调整后的风险比[aHR]：2.12，95%置信区间[CI] 0.75-6.02）、大出血事件（aHR：1.17，95%）没有观察到显着差异。接受标准剂量和低剂量阿哌沙班的患者之间的死亡率（CI 0.50–2.73）和全因死亡（aHR：1.95，95% CI 0.78–4.89）。接受标准剂量和低剂量阿哌沙班治疗的 AF 和 LVO 患者之间，缺血事件、大出血事件或全因死亡的发生率没有显着差异。