Management of antiplatelet medication in patients hospitalized with ischaemic stroke

November 2007

The use of antiplatelet agents in patients hospitalized with ischaemic stroke was studied using a large national hospital database. The study evaluated adherence to current consensus guidelines on antiplatelet use.

Prof Nancy A Nickman and her colleagues from the Pharmacotherapy Outcomes Research Center, University of Utah, USA, included 58,363 patients presenting with a primary or secondary diagnosis of noncardiogenic, thrombotic ischaemic stroke from January 2002 to December 2004 in their analysis. Patients were subdivided into four treatment groups (N=44,108) and one no-treatment group (N=14,255), based on whether their records showed that they were charged for any of four antiplatelet regimens at any time during hospitalization
(Figure 1):

• low-dose aspirin 325 mg daily (N=18,078)
• extended-release dipyridamole 200 mg + aspirin 25 mg (N=3,544)
• clopidogrel 75 mg (N=10,055)
• clopidogrel 75 mg [as the bisulfate] + low-dose aspirin (N=11,096)

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 patients in the treatment group. Usage rates of both fibrinolytic agents and vitamin K were higher in the no-treatment group. Aspirin alone was the most frequent antiplatelet medication used in 50.4% of the patients in the treatment group. More patients in the treatment group were discharged home or into rehabilitation, and more patients in the no-treatment group were either discharged to another nursing facility or died before discharge.

The authors evaluated antiplatelet agent changes beginning at any time during hospitalization and tracked them to the day of discharge (Table 1). By the time of discharge, patients in the treatment group had a 68% reduction in low-dose aspirin alone prescribing, some of which could be credited to the addition of clopidogrel to their low-dose aspirin regimen (121% increase in use of the combination). This change also resulted in an 8.5% net reduction of clopidogrel use as monotherapy. The use of extended-release dipyridamole plus aspirin increased even more by 150% between admission and discharge.

The authors pointed out that their 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. They underlined that outcomes for such patients were poorer than for patients who had received antiplatelet therapy and highly recommended antiplatelet therapy for secondary stroke prevention.