Jay B Lusk1, Haolin Xu2, Eric D Peterson3, Deepak L Bhatt4, Gregg C Fonarow5, Eric E Smith6, Roland Matsouaka2,7, Lee H Schwamm8, Ying Xian9. 1. Duke University School of Medicine, Durham, NC (J.B.L.). 2. Duke Clinical Research Institute, Durham, NC (H.X., R.M.). 3. Division of Cardiology (E.D.P.), University of Texas Southwestern Medical Center, Dallas, TX. 4. Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.). 5. Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). 6. Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.). 7. Department of Biostatistics and Bioinformatics, Duke University, Durham NC (R.M.). 8. Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.). 9. Department of Neurology (Y.X.), University of Texas Southwestern Medical Center, Dallas, TX.
Abstract
BACKGROUND AND PURPOSE: Many older patients presenting with acute ischemic stroke were already taking aspirin before admission. However, the management strategy for patients with aspirin treatment failure has not been fully established. METHODS: We used data from the American Heart Association Get With The Guidelines Stroke Registry to describe discharge antithrombotic treatment patterns among Medicare beneficiaries with ischemic stroke who were taking aspirin before their stroke and were discharged alive from 1734 hospitals in the United States between October 2012 and December 2017. RESULTS: Of 261 634 ischemic stroke survivors, 100 016 (38.2%) were taking aspirin monotherapy before stroke. Among them, 44.4% of patients remained on aspirin monotherapy at discharge (20.9% 81 mg, 18.2% 325 mg, 5.3% other or unknown dose). The next most common therapy choice was dual antiplatelet therapy (24.6%), followed by clopidogrel monotherapy (17.8%). The remaining 13.2% of patients were discharged on either aspirin/dipyridamole, warfarin, or nonvitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotic therapy at all. CONCLUSIONS: Nearly half of patients with ischemic stroke while on preventive therapy with aspirin are discharged on aspirin monotherapy without changing antithrombotic class, while the other half are discharged on clopidogrel monotherapy, dual antiplatelet therapy, or other less common agents. These findings emphasize the need for future research to identify best management strategies for this very common and complex clinical scenario.
BACKGROUND AND PURPOSE: Many older patients presenting with acute ischemic stroke were already taking aspirin before admission. However, the management strategy for patients with aspirin treatment failure has not been fully established. METHODS: We used data from the American Heart Association Get With The Guidelines Stroke Registry to describe discharge antithrombotic treatment patterns among Medicare beneficiaries with ischemic stroke who were taking aspirin before their stroke and were discharged alive from 1734 hospitals in the United States between October 2012 and December 2017. RESULTS: Of 261 634 ischemic stroke survivors, 100 016 (38.2%) were taking aspirin monotherapy before stroke. Among them, 44.4% of patients remained on aspirin monotherapy at discharge (20.9% 81 mg, 18.2% 325 mg, 5.3% other or unknown dose). The next most common therapy choice was dual antiplatelet therapy (24.6%), followed by clopidogrel monotherapy (17.8%). The remaining 13.2% of patients were discharged on either aspirin/dipyridamole, warfarin, or nonvitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotic therapy at all. CONCLUSIONS: Nearly half of patients with ischemic stroke while on preventive therapy with aspirin are discharged on aspirin monotherapy without changing antithrombotic class, while the other half are discharged on clopidogrel monotherapy, dual antiplatelet therapy, or other less common agents. These findings emphasize the need for future research to identify best management strategies for this very common and complex clinical scenario.
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Authors: Ying Xian; Haolin Xu; Roland Matsouaka; Daniel T Laskowitz; Lesley Maisch; Deidre Hannah; Eric E Smith; Gregg C Fonarow; Deepak L Bhatt; Lee H Schwamm; Brian Mac Grory; Wuwei Feng; Emil Loldrup Fosbøl; Eric D Peterson; Mark Johnson Journal: JAMA Netw Open Date: 2022-07-01