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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Analysis of Treatment Pattern of Antiplatelet in First-Ever Ischemic Stroke Without Previous Antiplatelet Use: A
Soo-Hyun Park1, Kyung Joo Lee2, Jinseob Kim3
1Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Insights
The CHANCE trial significantly shifted antiplatelet prescribing for ischemic stroke patients in Korea, increasing dual antiplatelet therapy use. Aspirin remains common, but combination therapies now lead post-trial.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Cardiovascular disease is a leading cause of death globally and second in Korea.
- Antiplatelet agents are crucial for preventing cardiovascular events.
- Understanding real-world antiplatelet prescribing patterns is essential due to increasing demand.
Purpose of the Study:
- To analyze antiplatelet prescription trends in patients with first-ever ischemic stroke (IS) in Korea.
- To assess the impact of the 2013 CHANCE trial on prescribing patterns.
Main Methods:
- Analysis of 162,361 patients with first-ever IS using 11 Korean observational databases (1995-2023).
- Data transformed to a Common Data Model.
- Prescription shifts evaluated in relation to the CHANCE trial publication.
Main Results:
- Initial antiplatelet therapy: Aspirin (39.4%), Aspirin-Clopidogrel (28.2%), Clopidogrel (13.7%).
- Post-CHANCE trial: Aspirin-Clopidogrel combination became dominant (40.6%), followed by Aspirin (30.3%) and Clopidogrel (11.3%) monotherapy.
- Significant shift towards dual antiplatelet therapy (DAPT) after the CHANCE trial.
Conclusions:
- The CHANCE trial significantly influenced the increased use of DAPT for secondary IS prevention.
- Aspirin remains a primary agent, but DAPT use has risen notably.
- Ongoing analysis of antiplatelet patterns is vital for guideline implementation in clinical practice.
Background:
Antiplatelet agents are widely prescribed to prevent cardiovascular events, with cardiovascular disease being the leading global cause of death and the second most common in Korea. As the demand for antiplatelets increases, understanding real-world prescribing patterns is essential.
Methods:
This study analyzed antiplatelet prescription trends for patients with first-ever ischemic stroke (IS) using 11 Korean observational databases transformed to a Common Data Model, spanning 1995-2023. Prescription shifts were assessed in relation to the 2013 CHANCE trial.
Results:
The analysis included 162,361 patients with first-ever IS who had no prior antiplatelet therapy. Aspirin was the most commonly prescribed initial medication (39.4%), followed by aspirin-clopidogrel combination (28.2%), clopidogrel alone (13.7%), and cilostazol (5.0%). Initial medication were typically maintained: however, some patients initially on aspirin or clopidogrel switched to dual antiplatelet therapy (DAPT; aspirin and clopidogrel), while those on initial DAPT primarily transitioned to clopidogrel, then to aspirin. Following the CHANCE trial, a marked shift in prescription patterns was observed. Before CHANCE, aspirin was predominant (45.7%), followed by aspirin-clopidogrel (19.2%), and clopidogrel (15.5%). Post-CHANCE, aspirin-clopidogrel became the leading therapy (40.6%), with aspirin (30.3%) and clopidogrel (11.3%) monotherapy.
Conclusion:
While aspirin remains the mainstay for secondary prevention of IS, the CHANCE trial significantly influenced increased use of DAPT. As evidence continues to grow for P2Y12 inhibitors in the IS context, analyzing antiplatelet prescription patterns is vital for evaluating the implementation of guidelines in clinical practice.
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