Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East
Background and purposeGuidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1–3 days from onset should be offered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT us...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1269292/full |
| _version_ | 1797629757035118592 |
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| author | Hiba Naveed Naveed Akhtar Salman Al-Jerdi Ryan Ty Uy Sujatha Joseph Deborah Morgan Blessy Babu Shobana Shanthi Ashfaq Shuaib |
| author_facet | Hiba Naveed Naveed Akhtar Salman Al-Jerdi Ryan Ty Uy Sujatha Joseph Deborah Morgan Blessy Babu Shobana Shanthi Ashfaq Shuaib |
| author_sort | Hiba Naveed |
| collection | DOAJ |
| description | Background and purposeGuidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1–3 days from onset should be offered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective database.MethodsThe Qatar Stroke Database began the enrollment of patients with TIAs and acute stroke in 2014 and currently has ~16,000 patients. For this study, we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with an ABCD2 score of 4, and a minor stroke was defined as an NIHSS of 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed.ResultsAfter excluding patients with ICH, mimics, and rare secondary causes, 8,082 patients were available for final analysis (TIAs: 1,357 and stroke: 6,725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor strokes, 1,207 of 3,572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately offered to 238 of 691 (34.4%) low-risk TIAs and 809 of 3,153 (25.7%) non-minor stroke patients.ConclusionThis large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from the hospital. This requires urgent attention and further investigation. |
| first_indexed | 2024-03-11T10:57:31Z |
| format | Article |
| id | doaj.art-b02108622a1940b28fb694602b9396a2 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T10:57:31Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-b02108622a1940b28fb694602b9396a22023-11-13T04:27:55ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-11-011410.3389/fneur.2023.12692921269292Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle EastHiba Naveed0Naveed Akhtar1Salman Al-Jerdi2Ryan Ty Uy3Sujatha Joseph4Deborah Morgan5Blessy Babu6Shobana Shanthi7Ashfaq Shuaib8Department of Medical Education, Weill Cornell College of Medicine, Doha, QatarThe Neuroscience Institute, Hamad Medical Corporation, Doha, QatarDepartment of Medical Education, Weill Cornell College of Medicine, Doha, QatarThe Neuroscience Institute, Hamad Medical Corporation, Doha, QatarThe Neuroscience Institute, Hamad Medical Corporation, Doha, QatarThe Neuroscience Institute, Hamad Medical Corporation, Doha, QatarThe Neuroscience Institute, Hamad Medical Corporation, Doha, QatarThe Neuroscience Institute, Hamad Medical Corporation, Doha, QatarNeurology Division, Department of Medicine, University of Alberta, Edmonton, AB, CanadaBackground and purposeGuidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1–3 days from onset should be offered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective database.MethodsThe Qatar Stroke Database began the enrollment of patients with TIAs and acute stroke in 2014 and currently has ~16,000 patients. For this study, we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with an ABCD2 score of 4, and a minor stroke was defined as an NIHSS of 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed.ResultsAfter excluding patients with ICH, mimics, and rare secondary causes, 8,082 patients were available for final analysis (TIAs: 1,357 and stroke: 6,725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor strokes, 1,207 of 3,572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately offered to 238 of 691 (34.4%) low-risk TIAs and 809 of 3,153 (25.7%) non-minor stroke patients.ConclusionThis large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from the hospital. This requires urgent attention and further investigation.https://www.frontiersin.org/articles/10.3389/fneur.2023.1269292/fullTIAstrokeantiplateletmodified Rankin scaleguidelinesDAPT |
| spellingShingle | Hiba Naveed Naveed Akhtar Salman Al-Jerdi Ryan Ty Uy Sujatha Joseph Deborah Morgan Blessy Babu Shobana Shanthi Ashfaq Shuaib Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East Frontiers in Neurology TIA stroke antiplatelet modified Rankin scale guidelines DAPT |
| title | Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East |
| title_full | Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East |
| title_fullStr | Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East |
| title_full_unstemmed | Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East |
| title_short | Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East |
| title_sort | appropriate use of antiplatelet medications following transient ischemic attacks and stroke a 9 year study from the middle east |
| topic | TIA stroke antiplatelet modified Rankin scale guidelines DAPT |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1269292/full |
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