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Use of antithrombotic agents among U.S. stroke survivors, 2000-2006
Eric M Cheng1, Stanley N Cohen, Martin L Lee
1Department of Neurology, University of California, Los Angeles, 90073, USA. eric.cheng@va.gov
Insights
Most stroke survivors use antithrombotic agents, but prescription antiplatelet use increased. Further research is needed to improve care for the 20% not using these vital secondary stroke prevention medications.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Public Health
Background:
- Secondary stroke prevention guidelines recommend antithrombotic agents, including aspirin, antiplatelet agents, and anticoagulants.
- Antithrombotic agents are crucial for reducing the risk of recurrent stroke.
- Understanding current usage patterns is vital for optimizing patient care.
Purpose of the Study:
- To determine if the use of outpatient antithrombotic agents has increased among stroke survivors.
- To identify trends in the utilization of medications for secondary stroke prevention.
- To assess the current landscape of antithrombotic agent use in the stroke survivor population.
Main Methods:
- Analysis of data from 4168 individuals with self-reported cerebrovascular disease from the 2000-2006 Medical Expenditure Panel Survey.
- Antithrombotic agent use assessed through in-person interviews (aspirin) and pharmacy records (prescription medications).
- Cochran-Armitage tests and multivariate models used to analyze temporal trends and predictors of antithrombotic agent use.
Main Results:
- Overall, 75% of stroke survivors used any antithrombotic agent, increasing to 81% when excluding those for whom aspirin was unsafe.
- Use of prescription antiplatelet agents significantly increased during the study period (p<0.001).
- No significant overall temporal change in antithrombotic agent use was observed; predictors included older age, male gender, non-Hispanic ethnicity, usual source of care, and poor health status.
Conclusions:
- A high percentage of stroke survivors utilize antithrombotic agents for secondary prevention.
- Further research is warranted to improve care for the approximately 20% of stroke survivors not using these agents.
- Targeted interventions may be necessary for younger, female, and Hispanic stroke survivors to enhance antithrombotic agent use.
Background:
Secondary stroke prevention guidelines recommend antithrombotic agents such as over-the-counter aspirin, prescription antiplatelet agents, or anticoagulant agents.
Purpose:
The study was designed to measure whether use of outpatient antithrombotic agents is increasing among stroke survivors.
Methods:
The sample consisted of 4168 people who self-reported cerebrovascular disease and who participated in the Medical Expenditure Panel Survey, an annual representative sample of the U.S., during the years 2000-2006. Use of antithrombotic agents was calculated from face-to-face interviews about the use of aspirin and from pharmacies about the use of prescription medications. Cochran-Armitage tests were used to detect temporal trends and multivariate models to identify predictors of use of antithrombotic agents.
Results:
Pooling results across the 7 years, it was found that 57% were taking aspirin, 66% were using any antiplatelet agent, and 75% were using any antithrombotic agent. After excluding people who said aspirin was unsafe, 81% were using any antithrombotic agent. During the study period, use of prescription antiplatelet agents increased (p<0.001) but there was no temporal change in use of antithrombotic agents overall. In multivariate models, being aged >65 years, male gender, non-Hispanic ethnicity, having a usual source of care, and poor or fair health status were associated with use of an antithrombotic agent (p<0.05).
Conclusions:
Although a high percentage of stroke survivors appear to use an antithrombotic agent, further research should investigate whether and how to improve care among the remaining 20% of stroke survivors, particularly among younger, female, and Hispanic patients.
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