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Antiplatelet prescribing patterns for TIA and ischemic stroke: the Indiana University experience
1Department of Neurology, Indiana University School of Medicine, 545 Barnhill Drive, EH 125, Indianapolis 46202-5124, USA.
Insights
Aspirin is the preferred first-line antiplatelet therapy for secondary stroke prevention. For patients not on prior therapy, low-dose aspirin is common, while those on therapy often have their aspirin dose increased or clopidogrel added.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Four antiplatelet therapies exist for secondary stroke prevention.
- Physicians select agents based on various factors due to differing mechanisms of action.
Purpose of the Study:
- Evaluate antiplatelet prescribing patterns in neurology at Indiana University Hospital.
- Identify factors influencing antiplatelet agent selection.
- Analyze changes in therapy for recurrent cerebrovascular events.
Main Methods:
- Retrospective chart review of neurology patients with non-fatal ischemic stroke or TIA.
- Exclusion criteria included non-stroke diagnoses, clinical trial enrollment, or warfarin use.
- Analysis of antiplatelet agents prescribed at discharge.
Main Results:
- 177 patients with non-fatal ischemic stroke or TIA were analyzed.
- Aspirin was the most common agent for new therapy, often low-dose.
- Existing therapy involved aspirin dose increase or combination therapy.
Conclusions:
- Aspirin is supported as a first-line agent for secondary stroke prevention.
- Low-dose aspirin is favored for antiplatelet-naive patients.
- Aspirin dose escalation or addition of clopidogrel is common for patients on prior therapy.
Objective:
To evaluate antiplatelet prescribing patterns by Indiana University Hospital (IU) neurologists, determine what drives antiplatelet agent decisions, and determine changes made with recurrent cerebrovascular events despite proven antiplatelet therapy. There are now four approved therapies for secondary prevention of cerebrovascular events. As these agents exhibit their effects through different pathways, physicians must choose antiplatelet agents based on other factors.
Design:
We retrospectively reviewed charts of neurology patients diagnosed with non-fatal ischemic stroke or TIA at IU from January 1, 1997 to August 31, 2001. Patients were excluded if: discharge diagnosis was not non-fatal ischemic stroke or TIA, they were enrolled in clinical trials, or were placed on anticoagulation therapy with warfarin. Patients' antiplatelet agents at discharge were reviewed to determine if specific factors led to the choice of antiplatelet agent.
Results:
A total of 177 patients experienced non-fatal ischemic strokes or TIAs. Of these, 74 were not on prior antiplatelet therapy and 103 were on antiplatelet agents prior to admission. For patients not on therapy, aspirin was the most commonly prescribed agent, with a trend for low-dose aspirin. For patients already on an antiplatelet agent, typically the dose of aspirin was increased or combination therapy initiated.
Conclusion:
Our experience supports the use of aspirin as a first-line agent for secondary prevention in cerebrovascular disease. For antiplatelet-nai;ve patients, low-dose aspirin is the most frequently used agent. For patients previously on antiplatelet agents, aspirin dosage is increased or clopidogrel is added. High-dose aspirin and ticlopidine use is no longer favored.