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Updated: Mar 17, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke
Phyo K Myint1, Anne S Hellkamp2, Gregg C Fonarow2
1From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.). phyo.myint@abdn.ac.uk.
Insights
Previous use of antithrombotic medications is linked to better outcomes for acute ischemic stroke patients. This includes lower mortality and improved functional status at discharge, regardless of prior vascular conditions.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Antithrombotics are crucial for stroke prevention.
- Pre-stroke antithrombotic use may improve outcomes after an acute event.
Purpose of the Study:
- To examine the association between pre-stroke antithrombotic use and clinical outcomes in acute ischemic stroke patients.
- To determine if prior vascular indications modify this association.
Main Methods:
- Analysis of a large cohort (n=540,993) from the Get With The Guidelines-Stroke registry (Oct 2011-Mar 2014).
- Examined associations between previous antithrombotic use and in-hospital mortality, discharge destination, ambulatory status, and modified Rankin Scale score.
- Adjusted for clinical and hospital factors.
Main Results:
- 46% of stroke patients were not on antithrombotics prior to their event.
- Patients on antithrombotics before stroke had significantly better outcomes.
- Adjusted odds ratios showed lower mortality (0.82) and improved functional outcomes (discharge home, independent ambulation, mRS 0-1).
Conclusions:
- Pre-stroke antithrombotic therapy is independently associated with improved clinical outcomes in acute ischemic stroke.
- Benefits extend beyond stroke prevention, highlighting the importance of appropriate antithrombotic use.
Background And Purpose:
Antithrombotics are the mainstay of treatment in primary and secondary prevention of stroke, and their use before an acute event may be associated with better outcomes.
Methods:
Using data from Get With The Guidelines-Stroke with over half a million acute ischemic strokes recorded between October 2011 and March 2014 (n=540 993) from 1661 hospitals across the United States, we examined the unadjusted and adjusted associations between previous antithrombotic use and clinical outcomes.
Results:
There were 250 104 (46%) stroke patients not receiving any antithrombotic before stroke; of whom approximately one third had a documented previous vascular indication. After controlling for clinical and hospital factors, patients who were receiving antithrombotics before stroke had better outcomes than those who did not, regardless of whether a previous vascular indication was present or not: adjusted odds ratio (95% confidence intervals) were 0.82 (0.80-0.84) for in-hospital mortality, 1.18 (1.16-1.19) for home as the discharge destination, 1.15 (1.13-1.16) for independent ambulatory status at discharge, and 1.15 (1.12-1.17) for discharge modified Rankin Scale score of 0 or 1.
Conclusions:
Previous antithrombotic therapy was independently associated with improved clinical outcomes after acute ischemic stroke. Ensuring the use of antithrombotics in appropriate patient populations may be associated with benefits beyond stroke prevention.
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