scholarly journals The decrease in hospitalizations for transient ischemic attack and ischemic stroke, especially in mild cases, during the COVID-19 epidemic in Japan

2020 ◽  
Author(s):  
Hiroyuki Nagano ◽  
Daisuke Takada ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Number Of Patients ◽  
Stroke Diagnosis ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

AbstractBackground and PurposeThe epidemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study was to assess the impact of the COVID-19 epidemic on hospital admissions for stroke in Japan.MethodsWe analyzed administrative (Diagnosis Procedure Combination) data for cases of inpatients aged 18 years and older who were diagnosed with stroke (ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, or subarachnoid hemorrhage (SAH)) and discharged from hospital during the period July 1, 2018 to June 30, 2020. The number of patients with each stroke diagnosis, various patient characteristics, and treatment approaches were compared before and after the epidemic. Changes in the trend of the monthly number of inpatients with each stroke diagnosis were assessed using interrupted time-series analyses.ResultsA total of 111,922 cases (ischemic stroke: 74,897 cases; TIA: 5,374 cases; hemorrhagic stroke: 24,779 cases; SAH: 6,872 cases) in 253 hospitals were included. The number of cases for all types of stroke decreased (ischemic stroke: -13.9%; TIA: -21.4%; hemorrhagic stroke: -9.9%; SAH: -15.2%) in April and May 2020, compared to the number of cases in 2019. Ischemic stroke and TIA cases, especially mild cases (modified Rankin Scale = 0), decreased, with a statistically significant change in trend between the before- and after-epidemic periods.ConclusionsThese data showed a marked reduction in the number of hospital admissions due to stroke during the COVID-19 epidemic. The change in Ischemic stroke and TIA cases, especially mild cases, was statistically significant.

scholarly journals Acute Stroke in Times of the COVID-19 Pandemic

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2224-2227 ◽  
Author(s):  
Carolin Hoyer ◽  
Anne Ebert ◽  
Hagen B. Huttner ◽  
Volker Puetz ◽  
Bernd Kallmünzer ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Hospital Admissions ◽  
Social Distancing ◽  
Admission Rates ◽  
Cerebrovascular Events ◽  
Number Of Patients ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic. Methods: In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack. Results: Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (−85%, −46%, −42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, −60%; thrombectomy, −61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers. Conclusions: These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.

Clinical Effects of Dual Antiplatelet Therapy or Aspirin Monotherapy after Acute Minor Ischemic Stroke or Transient Ischemic Attack, a Meta-Analysis

2021 ◽  
Vol 27 ◽  
Author(s):  
Francesco Condello ◽  
Gaetano Liccardo ◽  
Giuseppe Ferrante
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Stroke Recurrence ◽  
Controlled Trials ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Background: Evidence about the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with acute minor ischemic stroke or transient ischemic attack (TIA) is emerging. The aim of our study was to provide an updated and comprehensive analysis about the risks and benefits of DAPT versus aspirin monotherapy in this setting. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov databases, main international conference proceedings were searched for randomized controlled trials comparing DAPT versus aspirin monotherapy in patients with acute ischemic stroke or TIA not eligible for thrombolysis or thrombectomy presenting in the first 24 hours after the acute event. Data were pooled by meta-analysis using a random-effects model. The primary efficacy endpoint was ischemic stroke recurrence, and the primary safety outcome was major bleeding. Secondary endpoints were intracranial hemorrhage, hemorrhagic stroke, and all-cause death. Results: A total of 4 studies enrolling 21,459 patients were included. DAPT with clopidogrel was used in 3 studies, DAPT with ticagrelor in one study. DAPT duration was 21 days in one study, 1 month in one study, and 3 months in the remaining studies. DAPT was associated with a significant reduction in the risk of ischemic stroke recurrence (relative risk [RR], 0.74; 95% confidence interval [CI], 0.67-0.82, P<0.001, number needed to treat 50 [95% CI 40-72], while it was associated with a significantly higher risk of major bleeding (RR, 2.59; 95% CI 1.49-4.53, P=0.001, number needed to harm 330 [95% CI 149-1111]), of intracranial hemorrhage (RR 3.06, 95% CI 1.41-6.66, P=0.005), with a trend towards higher risk of hemorrhagic stroke (RR 1.83, 95% CI 0.83-4.05, P=0.14), and a slight tendency towards higher risk of all-cause death (RR 1.30, 95% CI 0.89-1.89, P=0.16). Conclusions: Among patients with acute minor ischemic stroke or TIA, DAPT, as compared with aspirin monotherapy, might offer better effectiveness in terms of ischemic stroke recurrence at the expense of a higher risk of major bleeding. The trade-off between ischemic benefits and bleeding risks should be assessed in tailoring the therapeutic strategies.

scholarly journals Hospitalization for ischemic stroke was affected more in independent cases than in dependent cases during the COVID-19 pandemic: An interrupted time series analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261587
Author(s):  
Hiroyuki Nagano ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Daisuke Takada ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Time Series ◽  
Ischemic Stroke ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
State Of Emergency ◽  
Its Analysis ◽  
Care Systems ◽  
The Impact

Background The pandemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study is to assess the impact of the COVID-19 pandemic on the number of hospital admissions for ischemic stroke by severity in Japan. Methods We analysed administrative (Diagnosis Procedure Combination—DPC) data for cases of inpatients aged 18 years and older who were diagnosed with ischemic stroke and admitted during the period April 1 2018 to June 27 2020. Levels of change of the weekly number of inpatient cases with ischemic stroke diagnosis after the declaration of state of emergency were assessed using interrupted time-series (ITS) analysis. The numbers of patients with various characteristics and treatment approaches were compared. We also performed an ITS analysis for each group (“independent” or “dependent”) divided based on components of activities of daily living (ADL) and level of consciousness at hospital admission. Results A total of 170,294 cases in 567 hospitals were included. The ITS analysis showed a significant decrease in the weekly number of ischemic stroke cases hospitalized (estimated decrease: −156 cases; 95% confidence interval (CI): −209 to −104), which corresponds to −10.4% (95% CI: −13.6 to −7.1). The proportion of decline in the independent group (−21.3%; 95% CI: −26.0 to −16.2) was larger than that in the dependent group (−8.6%; 95% CI: −11.7 to −5.4). Conclusions Our results show a marked reduction in hospital admissions due to ischemic stroke after the declaration of the state of emergency for the COVID-19 pandemic. The independent cases were affected more in proportion than dependent cases.

Abstract T P139: Prevalence and Predictors of Mood Disorders among a National Sample of Individuals with Stroke or Transient Ischemic Attack

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ali Razmara ◽  
Steven Cen ◽  
Diana L Jin ◽  
Nerses Sanossian ◽  
Amytis Towfighi
Keyword(s):  
Ischemic Stroke ◽  
Mood Disorders ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Private Insurance ◽  
National Sample ◽  
Psychiatric Disease ◽  
Stroke Risk Factor ◽  
Hospital Factors ◽  
Ischemic Attack

Intro: Depression is an independent stroke risk factor, yet little is known about comorbid mood disorders prevalence in stroke survivors. Data regarding association between mood disorders and transient ischemic attack (TIA) are scarce. Objective: To determine prevalence and predictors of comorbid mood disorders among individuals hospitalized with TIA, ischemic stroke, and hemorrhagic stroke in a national US sample. Methods: Using Nationwide Inpatient Sample (NIS) data (2000-2010), we identified individuals discharged with a primary diagnosis of acute ischemic stroke, hemorrhagic stroke, or TIA. We determined the weighted proportion of stroke hospitalizations with comorbid mood disorders (bipolar affective disorder, depression, anxiety disorders). We used survey weighted Poisson regression to estimate risk ratios. The first multivariable model adjusted for sociodemographic and hospital factors. The second model also adjusted for comorbid conditions. Results: Among 2,057,799 hospital discharges for stroke or TIA (corresponding to 10.1 million individuals in US), 83,705 (4.07%) had mood disorders. Compared to those without mood disorders, individuals with mood disorders were younger and more likely to be female, White, and had higher income and private insurance. Individuals 84 years (RR 3.61, 95% CI 3.50-3.72) after adjustment for sociodemographic and hospital factors. Further adjustment for comorbidities slightly attenuated the association (RR 3.30, 95% CL 3.19-3.40). Women were twice as likely to have mood disorders (RR 1.94, 95% CI 1.91-1.97), after adjusting for sociodemographic and hospital factors. Further adjustment for comorbidities did not affect the association. Compared to Whites, all other races were less likely to have mood disorders. Conclusions: In this national sample of individuals admitted with stroke or TIA, 4% had mood disorders. This is likely an underestimate, given lack of systematic screening for comorbid psychiatric disease. Women, younger individuals, and Whites appear to be a population at risk; however, further studies are needed to determine the true prevalence of mood disorders among individuals with TIA/stroke, to determine impact on stroke recovery and optimal treatment options.

scholarly journals Redefinition of Transient Ischemic Attack Improves Prognosis of Transient Ischemic Attack and Ischemic Stroke

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3612-3613 ◽  
Author(s):  
Michael T. Mullen ◽  
Brett L. Cucchiara
Keyword(s):  
Magnetic Resonance Imaging ◽  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Resonance Imaging ◽  
Acute Infarction ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose— The recent redefinition of transient ischemic attack (TIA) reclassifies patients with acute infarction on magnetic resonance imaging as ischemic stroke. Redefinition will improve the prognosis of both TIA and ischemic stroke, an epidemiological paradox known as the Will Rogers phenomenon. We sought to quantify the impact of this phenomenon. Methods— Incidence of TIA, risk of death/disability after stroke, rate of acute infarction on magnetic resonance imaging after TIA, and 90-day stroke risk after TIA with and without infarction on magnetic resonance imaging were determined based on published data. The impact on poststroke disability in the redefined cohort of patients with ischemic stroke was computed. A sensitivity analysis was performed to account for uncertainty in input variables. Results— Using the new TIA definition, the 90-day risk of stroke following TIA is 1%. In the United States, redefinition will increase annual ischemic stroke incidence from 691 650 to 747 755 and result in a 3.4% absolute reduction in poststroke disability. In a sensitivity analysis, this risk reduction varies from 1.5 to 6.5%, and is most dependent on the incidence of TIA. Conclusions— Redefinition of TIA reduces stroke risk after TIA to approximately 1% at 90 days, and reduces the rate of poststroke disability by approximately 3.4%.

scholarly journals Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2315-2321 ◽  
Author(s):  
Henrique Diegoli ◽  
Pedro S.C. Magalhães ◽  
Sheila C.O. Martins ◽  
Carla H.C. Moro ◽  
Paulo H.C. França ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Statistical Tests ◽  
Stroke Care ◽  
Population Based ◽  
Public Authorities ◽  
Stroke Incidence ◽  
Stroke Registry ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil. Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019. Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 ( P =0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage. Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.

Lipid-Lowering Therapy and Hemorrhagic Stroke Risk: Comparative Meta-Analysis of Statins and PCSK9 Inhibitors

Stroke ◽  
2021 ◽  
Author(s):  
Borja E. Sanz-Cuesta ◽  
Jeffrey L. Saver
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Relative Risk ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Medication Dose ◽  
Ischemic Attack

Background and Purpose: Statins were shown to increase hemorrhagic stroke (HS) in patients with a first cerebrovascular event in 2006 (SPARCL), likely due to off-target antithrombotic effects, but continued to sometimes be used in patients with elevated HS risk due to absence of alternative medications. Recently, the PCSK9Is (proprotein convertase subtilisin kexin 9 inhibitors) have become available as a potent lipid-lowering class with potentially less hemorrhagic propensity. Methods: We performed a systematic comparative meta-analysis assessing HS rates across all completed statin and PCSK9I randomized clinical trials with treatment >3 months, following PRISMA guidelines. In addition to HS rates across all trials, causal relation was probed by evaluating for dose-response relationships by medication (low versus high medication dose/potency) and by presence and type of preceding brain vascular events at inception (none versus ischemic stroke/transient ischemic attack versus HS). Results: The systematic review identified 36 statin randomized clinical trials (204 918 patients) and 5 PCSK9I randomized clinical trials (76 140 patients). Across all patient types and all medication doses/potencies, statins were associated with increased HS: relative risk 1.15, P =0.04; PCSK9Is were not ( P =0.77). In the medication dose/potency analysis, higher dose/potency statins (7 trials, 62 204 patients) were associated with magnified HS risk: relative risk, 1.53; P =0.002; higher dose/potency PCSK9Is (1 trial, 27 564 patients) were not ( P =0.99). In the type of index brain vascular injury analysis for statins (5 trials, 9772 patients), prior ischemic stroke/transient ischemic attack was associated with a magnified risk of HS: relative risk, 1.43; P =0.04; and index intracerebral hemorrhage was associated with an extremely high effect estimate of risk of recurrent HS: hazard ratio, 4.06. For PCSK9Is, prior ischemic stroke/transient ischemic attack (1 trial, 5337 patients) was not associated with increased HS risk ( P =0.97). Conclusions: Statins increase the risk of HS in a medication dose- and type of index brain vascular injury-dependent manner; PCSK9Is do not increase HS risk. PCSK9Is may be a preferred lipid-lowering medication class in patients with elevated HS risk, including patients with prior HS.

scholarly journals KARAKTERISTIK DAN OUTCOME PASIEN-PASIEN PENYAKIT NEUROLOGIS

2017 ◽  
Vol 17 (3) ◽  
pp. 168-173
Author(s):  
Imran Imran
Keyword(s):  
Ischemic Stroke ◽  
Brain Tumor ◽  
Head Injury ◽  
Ct Scan ◽  
Data Base ◽  
Transient Ischemic Attack ◽  
Severe Head Injury ◽  
Hemorrhagic Stroke ◽  
Ischemic Attack ◽  
Guillain Barré

Abstrak. Penyakit neurologis merupakan salah satu masalah kesehatan masyarakat yang memerlukan kebijakan khusus dalam upaya penanganannya sehingga diperlukan data yang lengkap mengenai penyebab, perkembangan dan outcome.Penelitian ini bertujuan untuk mengetahui karakteristik, diagnosis klinis, hasil pemeriksaan penunjang (laboratorium, foto Rontgen, CT-scan, MRI), keadaaan klinis (saat masuk dan keluar rumah sakit), dan outcome pasien yang dirawat inap di ruang saraf RS Zainoel AbidinBanda Aceh. Ini merupakan penelitian observasional deskriptif. Sampel penelitian  adalah semua pasien yang dirawat inap di ruang saraf.Data karakteristik sampel dan semua varibel data penelitian ditabulasi menggunakan software data base rumah sakit. Pasien yang dirawat selama periode penelitian adalah 406 orang terdiri atas 227(55.9%)  pria dan 179(44.1%)wanita. Terdapat 20 jenis penyakit secara berurutan yaitu: stroke iskemik, cedera kepala ringan, cedera kepala sedang, cedera kepala berat, stroke hemoragik, sefalgia, mielopati, vertigo, brain tumor, epilepsi, radikulopati lumbal, Sindroma Guillain Barre, meningitis, hipertensi emergensi, hidrosefalus, ensefalitis, Transient Ischemic Attack, demensia, meningoensefalitis, trauma medulla spinalis.Terdapat 2 macam penyakit yang merupakan penyakit-penyakit yang dominan yang menyebabkan pasien dirawat di ruang saraf secara yaitu 1. Stroke iskemik dan hemoragik, dan 2. Cedera kepala (ringan,sedang,berat). Umumnya didominasi oleh pasien cedera kepala dan stroke.Berdasarkan outcome klinis pasien yang bertahan hidup sebanyak 385 (94.8) dan yang meninggal dunia sebanyak 21 (5.2%) orang terdiri atas 7 (1.7%)pasien stroke iskemik, 6(1.5%) pasien stroke hemoragik,3(0.7%) pasien cedera kepala berat dan masing-masing 1(0.2%) pasien meningitis, sefalgia, hidrosefalus, dan ensefalitis. Kata kunci:data neurobase, penyakit neurologis, outcome, RSZainoel Abidin. Abstract. Neurological disease is one of the public health problems that require special policies in the handling effort so that complete data on causes, developments and outcomes are needed. This study aims to determine the characteristics, clinical diagnosis, results of investigations (laboratory, X-ray, CT-scan, MRI), clinical conditions (admission and exit the hospital), and inpatients outcome of  the Zainoel Abidin Hospital Banda Aceh. This is a descriptive observational study. The sample were all inpatients.The sample characteristic data and all variables of the study data were tabulated using hospital data base software. Neurologic inpatients during the study period were 406 consisting of 227 (55.9%) men and 179 (44.1%) women. There are 20 types of neurologic diseases patients, sequentially: ischemic stroke, mild head injury, moderate head injury, severe head injury, hemorrhagic stroke, cephalgia, myelopathy, vertigo, brain tumor, epilepsy, lumbar radiculopathy, Guillain Barre syndrome, meningitis, emergency hypertension, hydrocephalus, encephalitis, Transient Ischemic Attack, dementia, meningoencephalitis, spinal cord injury. There are 2 kinds of diseases which are the dominant diseases sequently is ischemic hemorrhagic stroke, simple, moderate,and severe head injury. Based on the clinical outcome of survival patients were 385 (94.8) and those who died as many as 21 (5.2%)consisted of 7(1.7%) ischemic stroke, 6(1.5%)  hemorrhagic stroke, 3(0.7%)  severe head injuries and 1(0.2%)  meningitis, cephalgia, hydrocephalus, and encephalitis.

Cerebral Microbleeds and Cognitive Function in Ischemic Stroke or Transient Ischemic Attack Patients

2015 ◽  
Vol 40 (3-4) ◽  
pp. 130-136 ◽  
Author(s):  
Zhaolu Wang ◽  
Adrian Wong ◽  
Wenyan Liu ◽  
Jie Yang ◽  
Winnie C.W. Chu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Transient Ischemic Attack ◽  
Cerebral Microbleeds ◽  
Cognitive Domains ◽  
Deep Region ◽  
Ischemic Attack ◽  
The Impact

Background: We explored the association between cerebral microbleeds (CMBs) and cognitive impairment in patients with ischemic stroke/transient ischemic attack (TIA). Methods: A total of 488 ischemic stroke/TIA patients received magnetic resonance imaging. Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive function and cognitive domains. The association of CMB quantity with cognitive function and the impact of CMB locations (strictly lobar, strictly deep, and mixed regions) on cognitive impairment were examined in regression models with adjustments for confounders. Results: A total of 113 subjects (23.2%) had ≥1 CMB. Strictly lobar, strictly deep, and mixed CMBs were identified in 36, 40, and 37 patients, respectively. The presence of ≥5 CMBs or strictly deep CMBs was associated with the MoCA total score (p = 0.007 and 0.020, respectively). Of all MoCA domains tested, a lower score in the attention domain was related to the presence of ≥5 CMBs (p = 0.014) and strictly deep CMBs (p = 0.028). Conclusion: CMBs were associated with cognitive dysfunction in stroke/TIA patients, especially in the attention domain. This association was mainly driven by CMBs in the deep region, underlining the role of hypertensive microangiopathy in stroke-related cognitive impairment.

Abstract 3066: Implementation of Results from Major Clinical Trials on Utilization Patterns of Antithrombotic Agents following Noncardioembolic Ischemic Stroke or TIA in the United States (2000-2009)

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amir Khan ◽  
Saqib A Chaudhry ◽  
M. Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
The United States ◽  
Match Trial ◽  
Before And After ◽  
History Of ◽  
Utilization Patterns ◽  
Artery Disease ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: Several large trials published over the last decade have significantly altered recommended guidelines for therapy following a noncardioembolic ischemic stroke or transient ischemic attack (TIA). We examined utilization patterns of these agents over the last decade, with regards to the publication of the MATCH, ESPRIT, and PRoFESS clinical trials, to study the implementation of the results of such trials in clinical practice. Methods: Antithrombotic utilization was prospectively collected as part of the National Ambulatory Medical Care Survey (NAMCS) between 2000 and 2009. Patients with a history of ischemic stroke or TIA were included with the exception of those with a concomitant history of atrial fibrillation, atrial flutter, or heart valve replacement. Annual utilization prevalence of the following antithrombotic strategies was compared: aspirin monotherapy, clopidogrel monotherapy, combined clopidogrel and aspirin, dipyridamole-aspirin, and warfarin. Average annual prevalence was compared before and after publication of MATCH in 2004, ESPRIT in 2006, and PRoFESS in 2008. A second pre-specified analysis excluded patients with known coronary artery disease (CAD) to censor the use of combined clopidogrel and aspirin for treatment of CAD after the 2001 CURE and 2002 CREDO trials showed a benefit of extended dual antiplatelet therapy. Results: An annual average of 4,221,059 patients between 2000 and 2009 met criteria for evaluation. After the 2004 MATCH trial, the annualized rate of combined clopidogrel and aspirin use increased from 3.3% before trial publication to 6.8% afterwards (p<0.0001). When patients with CAD were excluded an increase of 3.3% to 5.5% was found during the same period (p<0.0001). Following the 2006 ESPRIT trial, the annualized rate of dipyridamole-aspirin use increased from 2.8% to 4.6% (p<0.0001); the annualized rate of clopidogrel use increased from 12.8% to 17.8% (p<0.0001); and the annualized rate of aspirin use increased from 12.6% to 16% (p<0.0001). After the PRoFESS trial, published in late 2008, the annualized rate of clopidogrel use increased from 13.8% to 19% (p<0.0001); the annualized rate of dipyridamole-aspirin use minimally increased from 3.3% to 4% (p<0.0001); and the annualized rate of aspirin use decreased from 14.2% to 11% (p<0.0001). Conclusion: The impact of the MATCH, ESPRIT, and PRoFESS trials on antithrombotic utilization has been variable. The results highlight the importance of addressing factors that facilitate or hinder the implementation of results from such trials into practice.

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