Optimal Antithrombotic Therapy in Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation and Atherothrombosis

Inclusion Criteria:

1. Patients with an acute ischemic stroke or TIA from 8 days and up to 360 days fromthe onset of symptoms

2. Age 20 or older

3. Patients with non-valvular atrial fibrillation (chronic or paroxysmal) who start orcontinue taking an oral anticoagulant

4. Patients who have one of the following atherothrombotic diseases

5. A past history of ischemic heart disease (myocardial infarction, anginapectoris, coronary artery bypass graft (CABG), percutaneous coronaryintervention (PCI)

6. A past history of peripheral artery disease (symptomatic peripheral arterialocclusive disease, lower extremity bypass surgery/angioplasty/stenting)

7. Carotid artery stenosis (symptomatic or asymptomatic (=>50% diameter), ahistory of carotid artery stenting (CAS) or carotid endarterectomy (CEA))

8. Intracranial artery stenosis (=>50% stenosis of the diameter of a majorintracranial artery: intracranial internal carotid artery, anterior cerebralartery (ACA)-A1 and A2, middle cerebral artery (MCA)-M1 and M2, posteriorcerebral artery (PCA)-P1 and P2, vertebral artery, and basilar artery; ahistory of intracranial stent placement or intracranial bypass surgery)

9. A past history of atherothrombotic brain infarction, lacunar infarction, orbranch atheromatous disease

10. Patients without severe disability (modified Rankin Scale score =<4)

11. Patients who can take oral medications

12. Patients who can receive follow-up survey

13. Provision of written informed consent either directly or by a suitable surrogate

Exclusion Criteria:

1. History of myocardial infarction or acute coronary syndrome within the past 12months

2. Patients who underwent PCI with drug-eluting stents within the past 12 months or PCIwith bare-metal stents within the past 3 months

3. Patients who underwent carotid artery stent placement, intracranial stent placement,or lower extremity stent placement within the past 3 months

4. History of symptomatic intracranial hemorrhage or gastrointestinal bleeding withinthe past 6 months

5. Hemorrhagic diathesis or blood coagulation disorders

6. Platelet counts <100,000 /mm3 at enrollment.

7. Severe anemia (hemoglobin <7 g/dL)

8. Severe renal failure (creatinine clearance =<15 mL/min) or undergoing chronichemodialysis.

9. Severe liver dysfunction (Grade B or C of the Child-Pugh classification)

10. Patients with severe disability requires constant nursing care, bedridden (modifiedRankin Scale score =5)

11. Pregnant or possibly pregnant women

12. Active cancer

13. Expectation of survival less than 2 years

14. Anticoagulant or antiplatelet is scheduled to be discontinued for more than 4 weeksduring the follow-up period

15. Planned revascularization procedure during the follow-up period

16. Patients who are enrolled in other trials

17. Patients judged as inappropriate for this study by investigators