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Author Response: Association of Alternative Anticoagulation Strategies and Outcomes in Patients With Ischemic Stroke While Taking a Direct Oral Anticoagulant
Neurology ( IF 9.9 ) Pub Date : 2023-11-28
Ip, Y. M. B., Hong Leung, T. W.

We sincerely thank Wolfe et al. for the comments. The low rate of large artery atherosclerotic disease (LAD) in our atrial fibrillation (AF) cohort1 echoed our other study that among ischemic strokes, the proportion of intracranial atherosclerotic disease declined from 23.3% to 8.8% from 2004 to 2018 in Hong Kong.2 This difference may explain the disparity in LAD rates because the cohort of minor strokes/TIA quoted was recruited from 2011 to 2015.3 Moreover, elaborated as a limitation in the Discussion, underinvestigation of small-artery or large-artery atherosclerosis in apparent cardioembolic stroke might also contribute to the low LAD rate. Regarding tobacco consumption, the smoking prevalence in Hong Kong had been declining: The rate of older male smokers was 15.7%–17.5% and that of female was 1.2%–1.5% during the study period.4 Furthermore, we categorized smoking status after the first ischemic stroke despite direct oral anticoagulant, in which almost all patients did quit smoking. Future studies should determine whether ever-smoking may increase recurrent stroke risk in these patients. Finally, the study on minor stroke/TIA quoted was mainly associated with atherosclerosis, thus smoking.3 This may explain the higher smoking prevalence compared with our AF cohort.2

更新日期:2023-11-28
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