ISC 2026 | Prespecified subanalysis of ATIS-NVAF: OAC monotherapy versus OAC plus antiplatelet by AF type
Hiroshi Yamagami, MD, PhD, Osaka National Hospital, Osaka, Japan, discusses a prespecified subanalysis of the ATIS-NVAF trial (NCT03062319) investigating oral anticoagulant (OAC) monotherapy versus OAC plus antiplatelet therapy stratified by atrial fibrillation (AF) type. Prof. Yamagami reports differences in responses between paroxysmal and persistent AF. This interview took place at the 2026 International Stroke Congress (ISC), held in New Orleans, LA.
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Transcript
Okay, so the optimal antithrombotic therapy for the patient with stroke or TIA with both NVF and ASCVD is uncertain. So we conducted the ATIS-NVAF trial in which we randomized those patients to receive OAC plus antiplatelet combination therapy versus anti-coagulation monotherapy. And the main trial results show that OAC monotherapy is no benefit compared to the combination therapy, but the combination therapy had a more higher bleeding risk...
Okay, so the optimal antithrombotic therapy for the patient with stroke or TIA with both NVF and ASCVD is uncertain. So we conducted the ATIS-NVAF trial in which we randomized those patients to receive OAC plus antiplatelet combination therapy versus anti-coagulation monotherapy. And the main trial results show that OAC monotherapy is no benefit compared to the combination therapy, but the combination therapy had a more higher bleeding risk. And in this sub-analysis, we stratified based on the patient’s background data, based on AF type, persistent AF versus paroxysmal AF. And in paroxysmal AF groups, the combination therapy is also at higher risk of bleeding, but ischemic risk is even. However, the persistent AF group, the bleeding risk and the ischemic risk is even in treatment strategy. So maybe the optimal antithrombotic therapy should be thinking about the AF type. For the paroxysmal AF patients, maybe combination therapy is much stronger regarding the hemorrhagic risk.
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