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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Antiplatelet medication management in patients hospitalized with ischemic stroke
Nancy A Nickman1, Joseph Biskupiak, Freddy Creekmore
1Pharmacotherapy Outcomes Research Center, University of Utah, 421 Wakara Way, Suite 208, Salt Lake City, UT 84108, USA. nancy.nickman@pharm.utah.edu
Insights
Patients hospitalized with ischemic stroke who did not receive antiplatelet agents had worse outcomes. This study highlights the importance of antiplatelet therapy in acute stroke care for improved patient recovery and reduced healthcare costs.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Ischemic stroke is a leading cause of disability and mortality.
- Antiplatelet agents are crucial in managing ischemic stroke to prevent further thrombotic events.
- Current treatment guidelines recommend antiplatelet therapy for most acute ischemic stroke patients.
Purpose of the Study:
- To evaluate the impact of antiplatelet agent use in hospitalized patients with ischemic stroke.
- To compare outcomes between patients receiving antiplatelet therapy and those who did not.
- To identify the proportion of acute stroke patients undertreated with antiplatelet medications.
Main Methods:
- Retrospective analysis of a large national hospital database (2002-2004).
- Inclusion criteria: primary or secondary diagnosis of noncardiogenic, thrombotic ischemic stroke.
- Patients categorized into four antiplatelet treatment groups (aspirin, aspirin/dipyridamole, clopidogrel, clopidogrel/aspirin) and a no-treatment group.
Main Results:
- Over 58,000 patients analyzed; 25% did not receive antiplatelet agents during hospitalization.
- The no-treatment group experienced longer hospital stays, higher costs, and more comorbidities.
- Patients not receiving antiplatelet therapy had poorer discharge outcomes and higher mortality rates.
Conclusions:
- A significant proportion of acute ischemic stroke patients do not receive recommended antiplatelet therapy.
- Antiplatelet therapy is associated with improved outcomes, including better discharge disposition and reduced mortality.
- Findings underscore the need to optimize the use of antiplatelet agents in acute stroke management.
Purpose:
The use of antiplatelet agents in patients hospitalized with ischemic stroke was studied.
Methods:
Patients with a primary or secondary diagnosis of noncardiogenic, thrombotic ischemic stroke from January 2002 through December 2004 were included in the analysis. Patients were then subdivided into four treatment groups and one no-treatment group based on whether they were charged for any of four antiplatelet regimens (low-dose aspirin [=325 mg daily], extended-release dipyridamole 200 mg with aspirin 25 mg, clopidogrel 75 mg, and clopidogrel 75 mg [as the bisulfate] plus low-dose aspirin) at any time during hospitalization. Patients who did not receive any of these medications during hospitalization were defined as the no-treatment group. A patient's illness severity was measured and compared with other patients in the data set.
Results:
A total of 44,108 patients were assigned to the treatment group, and 14,255 patients were assigned to the no-treatment group. In general, longer lengths of stay and higher institutional costs were associated with the no-treatment group. Patients in the no-treatment group consistently displayed more comorbid conditions than did patients in the treatment group. The no-treatment group exhibited higher usage rates of both fibrinolytic agents and vitamin K. More patients in the treatment group were discharged to home or rehabilitation, while more patients in the no-treatment group were either discharged to another nursing facility or died before discharge.
Conclusion:
A retrospective analysis of a large national hospital database revealed that one quarter of patients who suffered an acute stroke did not receive antiplatelet drugs during their patient stay. Outcomes for such patients were poorer than for patients who had received antiplatelet therapy.
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