Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom
Abstract Introduction Stroke is a leading cause of death and disability worldwide. Antiplatelet therapies are recommended to reduce the risk of recurrent stroke in patients with ischemic stroke/transient ischemic attack (IS/TIA). This study evaluated outpatient antiplatelet treatment patterns and ou...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Adis, Springer Healthcare
2023-10-01
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| Series: | Cardiology and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40119-023-00332-7 |
| _version_ | 1797397704054145024 |
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| author | Xuejun Liu Jenny Jiang Danshi Li Jay Horrow Hiroshi Tamada Anja Kahl Vignesh Hariharan Ankur Avinav Xiaoyan Li |
| author_facet | Xuejun Liu Jenny Jiang Danshi Li Jay Horrow Hiroshi Tamada Anja Kahl Vignesh Hariharan Ankur Avinav Xiaoyan Li |
| author_sort | Xuejun Liu |
| collection | DOAJ |
| description | Abstract Introduction Stroke is a leading cause of death and disability worldwide. Antiplatelet therapies are recommended to reduce the risk of recurrent stroke in patients with ischemic stroke/transient ischemic attack (IS/TIA). This study evaluated outpatient antiplatelet treatment patterns and outcomes for secondary stroke prevention (SSP) among UK adults without atrial fibrillation who were hospitalized for IS/TIA. Methods This retrospective observational study utilized data from the UK Clinical Practice Research Datalink linked with Hospital Episode Statistics data (01/01/2011–30/06/2019). Treatment patterns included type and duration of treatments. Treatment outcomes included IS, myocardial infarction, major bleeding, and cardiovascular-related and all-cause mortality. Descriptive statistics were reported. Results Of 9270 patients, 13.9% (1292) might not receive antithrombotic therapy within 90 days of hospital discharge. Of 7978 patients who received antiplatelet therapies, most used clopidogrel (74.8%) or aspirin (16.7%) single antiplatelet therapy and clopidogrel + aspirin dual antiplatelet therapy (DAPT, 5.9%). At 1-year post-hospitalization, 36.9, 43.3, and 35.1% of those receiving these treatments discontinued them, respectively, and of the patients initiating DAPT, 62.3% switched to single antiplatelet therapy. At 1-year post-discharge, the incidence rate (per 100 person-years) of IS, myocardial infarction, major bleeding, cardiovascular-related mortality, and all-cause mortality among the treated were 6.5, 0.7, 4.1, 5.0, and 7.3, respectively, and among the untreated were 14.9, 0.7, 8.6, 28.1, and 39.8, respectively. Conclusions In the United Kingdom, 13.9% of patients hospitalized for stroke might not have any antiplatelet treatment to prevent secondary stroke; among the treated, clopidogrel, aspirin, and DAPT were commonly used. These study findings suggest that improved anti-thrombotic therapies for long-term SSP treatment are needed, which may lead to higher treatment and persistence rates and, therefore, improved outcomes in this population. |
| first_indexed | 2024-03-09T01:15:02Z |
| format | Article |
| id | doaj.art-ca6d1222dc194e81a3f211398f137012 |
| institution | Directory Open Access Journal |
| issn | 2193-8261 2193-6544 |
| language | English |
| last_indexed | 2024-03-09T01:15:02Z |
| publishDate | 2023-10-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Cardiology and Therapy |
| spelling | doaj.art-ca6d1222dc194e81a3f211398f1370122023-12-10T12:35:23ZengAdis, Springer HealthcareCardiology and Therapy2193-82612193-65442023-10-0112467568710.1007/s40119-023-00332-7Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United KingdomXuejun Liu0Jenny Jiang1Danshi Li2Jay Horrow3Hiroshi Tamada4Anja Kahl5Vignesh Hariharan6Ankur Avinav7Xiaoyan Li8Bristol Myers SquibbBristol Myers SquibbBristol Myers SquibbBristol Myers SquibbBristol Myers SquibbBristol Myers SquibbMu Sigma Inc.Mu Sigma Inc.Bristol Myers SquibbAbstract Introduction Stroke is a leading cause of death and disability worldwide. Antiplatelet therapies are recommended to reduce the risk of recurrent stroke in patients with ischemic stroke/transient ischemic attack (IS/TIA). This study evaluated outpatient antiplatelet treatment patterns and outcomes for secondary stroke prevention (SSP) among UK adults without atrial fibrillation who were hospitalized for IS/TIA. Methods This retrospective observational study utilized data from the UK Clinical Practice Research Datalink linked with Hospital Episode Statistics data (01/01/2011–30/06/2019). Treatment patterns included type and duration of treatments. Treatment outcomes included IS, myocardial infarction, major bleeding, and cardiovascular-related and all-cause mortality. Descriptive statistics were reported. Results Of 9270 patients, 13.9% (1292) might not receive antithrombotic therapy within 90 days of hospital discharge. Of 7978 patients who received antiplatelet therapies, most used clopidogrel (74.8%) or aspirin (16.7%) single antiplatelet therapy and clopidogrel + aspirin dual antiplatelet therapy (DAPT, 5.9%). At 1-year post-hospitalization, 36.9, 43.3, and 35.1% of those receiving these treatments discontinued them, respectively, and of the patients initiating DAPT, 62.3% switched to single antiplatelet therapy. At 1-year post-discharge, the incidence rate (per 100 person-years) of IS, myocardial infarction, major bleeding, cardiovascular-related mortality, and all-cause mortality among the treated were 6.5, 0.7, 4.1, 5.0, and 7.3, respectively, and among the untreated were 14.9, 0.7, 8.6, 28.1, and 39.8, respectively. Conclusions In the United Kingdom, 13.9% of patients hospitalized for stroke might not have any antiplatelet treatment to prevent secondary stroke; among the treated, clopidogrel, aspirin, and DAPT were commonly used. These study findings suggest that improved anti-thrombotic therapies for long-term SSP treatment are needed, which may lead to higher treatment and persistence rates and, therefore, improved outcomes in this population.https://doi.org/10.1007/s40119-023-00332-7Antiplatelet therapyDrug utilizationStrokeThrombosis |
| spellingShingle | Xuejun Liu Jenny Jiang Danshi Li Jay Horrow Hiroshi Tamada Anja Kahl Vignesh Hariharan Ankur Avinav Xiaoyan Li Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom Cardiology and Therapy Antiplatelet therapy Drug utilization Stroke Thrombosis |
| title | Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom |
| title_full | Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom |
| title_fullStr | Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom |
| title_full_unstemmed | Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom |
| title_short | Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom |
| title_sort | antiplatelet treatment patterns and outcomes for secondary stroke prevention in the united kingdom |
| topic | Antiplatelet therapy Drug utilization Stroke Thrombosis |
| url | https://doi.org/10.1007/s40119-023-00332-7 |
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