scholarly journals Antithrombotic Prescription at Discharge in Medicare Patients with Ischemic Stroke/Transient Ischemic Attack: Results from the National Stroke Project

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 376-377
Author(s):  
Timothy F Kresowik ◽  
David S Nilasena ◽  
Anton F Piskac ◽  
Rebecca A Hemann ◽  
Marian A Brenton ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Stroke Prevention ◽  
Antiplatelet Agents ◽  
Secondary Stroke Prevention ◽  
Antithrombotic Agents ◽  
Patterns Of Use ◽  
Medicare Patients ◽  
Ischemic Attack ◽  
Univariate Analyses

P205 Background: Antiplatelet agents have been shown to be effective for secondary stroke prevention in patients with ischemic stroke (IS) or transient ischemic attack (TIA). As part of HCFA’s National Stroke Project, we examined patterns of use of antithrombotic agents for inpatients with IS or TIA. Methods: Findings were based on abstracted data from a sample of Medicare inpatient medical records (discharge dates 4/98 - 3/99). All U.S. states, the District of Columbia and Puerto Rico were sampled using a systematic random approach. Each record had a principal diagnosis of one of the following ICD-9-CM codes: 362.34, 433.xx, 434.xx, 435.0, 435.1, 435.3, 435.8, 435.9 or 436. The main outcome measure was the frequency of eligible patients with a prescription or a plan for antithrombotic therapy at discharge. Antithrombotics were aspirin, clopidogrel, dipyridamole, ticlopidine and warfarin. Results: Of the 36,650 cases reviewed, 25,659 met the criteria for inclusion in the indicator. A large percentage of excluded cases (53.1%) were removed due to a history or current finding of hemorrhage. Nationwide, 20,947 (unadjusted rate 81.6%) patients were prescribed an antithrombotic at discharge or had a plan for starting an antithrombotic after discharge. The state-specific rates ranged from 72.0% to 90.1%. Univariate analyses showed this therapy was prescribed less frequently (p<0.001) for adults 85 years and over (rate=77.8%, OR=0.74, 95% CI=0.69–0.80), women (rate=80.4%, OR=0.83, 95% CI=0.78–0.89) and African-Americans (rate=77.6%, OR=0.76, 95% CI=0.68–0.85). Asians were found to have been prescribed this therapy more frequently than other races (p<0.02, rate=87.2%, OR=1.54 95% CI=1.10–2.16). Among those IS/TIA patients who also had atrial fibrillation (AF), 57.1% received warfarin. Conclusions: Antithrombotic agents are not prescribed for almost one-fifth of eligible Medicare inpatients with IS/TIA. For those with IS/TIA and AF, a large proportion are not treated with warfarin. These results show important opportunities for improvement in secondary stroke prevention for Medicare patients.

scholarly journals Antiplatelet therapy in stroke prevention after non-cardioembolic transient ischemic attack

2021 ◽  
Vol 13 (5) ◽  
pp. 14-19
Author(s):  
A. V. Fonyakin ◽  
L. A. Geraskina ◽  
M. Yu. Maksimova
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agents ◽  
Basic Principles ◽  
Advantages And Disadvantages ◽  
Minor Ischemic Stroke ◽  
New Ideas ◽  
Ischemic Attack

The review shows modern concepts on the role of antiplatelet therapy in the secondary prevention of cardiovascular diseases in patients after non-cardioembolic ischemic stroke or transient ischemic attack (TIA). We present an analytical characteristic of all antiplatelet agents that have been studied in randomized controlled trials worldwide. We demonstrate the advantages and disadvantages of each agent in monotherapy and in combination. New ideas about the rationality of the use of combined antiplatelet therapy with clopidogrel and acetylsalicylic acid in the first 24 hours and no more than 90 days in patients with minor ischemic stroke or TIA are discussed. The efficacy and safety of new antiplatelet agents are analyzed. The basic principles of choosing antiplatelet agents in patients after ischemic noncardioembolic stroke/TIA are outlined.

scholarly journals Antithrombotic Therapy for Secondary Prevention in Patients with Non-Cardioembolic Stroke or Transient Ischemic Attack: A Systematic Review

Life ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 447
Author(s):  
Dániel Tornyos ◽  
Alexandra Bálint ◽  
Péter Kupó ◽  
Oumaima El Alaoui El Abdallaoui ◽  
András Komócsi
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Randomized Controlled Trials ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agents ◽  
Cochrane Library ◽  
Stroke Recurrence ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Ischemic Attack

Stroke embodies one of the leading causes of death and disability worldwide. We aimed to provide a comprehensive insight into the effectiveness and safety of antiplatelet agents and anticoagulants in the secondary prevention of ischemic stroke or transient ischemic attack. A systematic search for randomized controlled trials, comparing antiplatelet or anticoagulant therapy versus aspirin or placebo among patients with ischemic stroke or transient ischemic attack, was performed in order to summarize data regarding the different regimens. Keyword-based searches in the MEDLINE, EMBASE, and Cochrane Library databases were conducted until the 1st of January 2021. Our search explored 46 randomized controlled trials involving ten antiplatelet agents, six combinations with aspirin, and four anticoagulant therapies. The review of the literature reflects that antiplatelet therapy improves outcome in patients with ischemic stroke or transient ischemic attack. Monotherapy proved to be an effective and safe choice, especially in patients with a high risk of bleeding. Intensified antiplatelet regimens further improve stroke recurrence; however, bleeding rate increases while mortality remains unaffected. Supplementing the clinical judgment of stroke treatment, assessment of bleeding risk is warranted to identify patients with the highest benefit of treatment intensification.

scholarly journals Benefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Stroke ◽  
2021 ◽  
Author(s):  
Devin L. Brown ◽  
Deborah A. Levine ◽  
Karen Albright ◽  
Moira K. Kapral ◽  
Lester Y. Leung ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Randomized Controlled Trials ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Stroke Prevention ◽  
Treatment Duration ◽  
Minor Stroke ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Ischemic Attack

BACKGROUND: Dual antiplatelet therapy (DAPT) after ischemic stroke or transient ischemic attack may reduce recurrent stroke but also increase severe bleeding compared with single antiplatelet therapy (SAPT). The American Heart Association/American Stroke Association convened an evidence review committee to perform a systematic review and meta-analysis of the benefits and risks of DAPT compared with SAPT for secondary ischemic stroke prevention. METHODS: The Medline, Embase, and Cochrane databases were searched on December 5, 2019, to identify phase III or IV randomized controlled trials (n≥100) from December 1999 to December 2019. We calculated unadjusted relative risks (RRs) and performed meta-analyses of studies based on the duration of treatment (short [≤90 days] versus long [>90 days]). RESULTS: Three short-duration randomized controlled trials were identified that enrolled mostly patients with minor stroke or high risk transient ischemic attack. In these trials, DAPT, compared with SAPT, was associated with a lower 90-day risk of recurrent ischemic stroke (pooled RR, 0.68 [95% CI, 0.55–0.83], I 2 =37.1%). There was no significant increase in major bleeding with DAPT in short-duration trials (pooled RR, 1.88 [95% CI, 0.93–3.83], I 2 =8.9%). In 2 long-duration treatment randomized controlled trials (mean treatment duration, 18-40 months), DAPT was not associated with a significant reduction in recurrent ischemic stroke (pooled RR, 0.89 [95% CI, 0.79–1.02], I 2 =1.4%), but was associated with a higher risk of major bleeding (pooled RR, 2.42 [95% CI, 1.37–4.30], I 2 =75.5%). CONCLUSIONS: DAPT was more effective than SAPT for prevention of secondary ischemic stroke when initiated early after the onset of minor stroke/high-risk transient ischemic attack and treatment duration was <90 days. However, when the treatment duration was longer and initiated later after stroke or transient ischemic attack onset, DAPT was not more effective than SAPT for ischemic stroke prevention and it increased the risk of bleeding.

scholarly journals Risk of Recurrent Ischemic Events in Patients with Symptomatic Vertebro-Basilar Stenosis

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 378-379
Author(s):  
Guven Uzun ◽  
Adnan Qureshi ◽  
Yousef M Mohammad ◽  
Osama Zaidat ◽  
Jose Suarez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Basilar Artery ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agents ◽  
High Rate ◽  
First Year ◽  
Long Term Outcome ◽  
Ischemic Attack ◽  
Ischemic Events

P216 Background and Purpose: The long-term outcome in patients with symptomatic vertebro-basilar stenosis is not well defined. We performed this study to determine the long-term risk of stroke or death in a large series of patients with vertebro-basilar stenosis. Methods: We identified patients admitted between January 1995 and December 1997 with ischemic stroke or transient ischemic attack related to stenosis in either the vertebral or basilar artery at 4 university hospitals. The stenosis was identified either by magnetic resonance angiography or conventional angiography. New ischemic events or death was identified during the follow-up period through clinic visits or telephone interviews. Results: A total of 77 patients (mean age 62.4 ±13.1 years; 43 were men) were identified with stenosis of either vertebral artery (n=28), basilar artery (n=26) or both (n=22). Of the 77 patients, 18 presented with transient ischemic attack and 59 with ischemic stroke. Eight patients died during hospitalization. Of the surviving 69 patients, 24 patients were treated with aspirin, 8 with ticlopidine or clopidogrel, 36 with warfarin and one patient received no treatment. The patients were followed for 47.4 ±35.8 months after the initial event. A total of 14 recurrent ischemic events were observed. The first year risk of new ischemic events for vertebro-basilar stenosis was 9%. The first year rate of ischemic events was similar between antiplatelet agents (9%) and warfarin (8%). Conclusions: A high rate of recurrent ischemic events was observed in patients with vertebro-basilar stenosis despite treatment with antiplatelet agents or anticoagulants.

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