Abstract Number: PB0101
Meeting: ISTH 2020 Congress
Background: Anticoagulants are indicated for the prevention of acute ischemic stroke (AIS) in patients with atrial fibrillation (AF). For AIS patients without AF, antiplatelets are recommended for the treatment and prevention of recurrent events. However, their actual use in clinical practice remains unclear.
Aims: This study characterized AIS patients without AF and the pattern of antithrombotic treatment in current clinical practice.
Methods: Hospitalized AIS patients without AF were identified from 4 US administrative claims databases, IBM MarketScan® Commercial Claims and Encounters (CCAE, aged 18-65 years), Multi‐state Medicaid (MDCD, aged ≥18 years), Medicare Supplemental Beneficiaries (MDCR, aged ≥65 years), and Optum´s de-identified Clinformatics® Data Mart Database (Optum, aged ≥18 years) during the period January-1-2008 to December-31-2018. Demographics and comorbidities in 6 months prior to hospitalization and treatment with antiplatelets (P2Y12 inhibitors [P2Y12i] and aggrenox) and anticoagulants (warfarin and direct oral anticoagulants [DOACs]) in 30 days after hospitalization were examined. Use of over-the-counter aspirin and in-hospital drug exposure were not captured in these databases.
Results: A total of 122,317, 77,979, 127,046, 172,415 AIS patients without AF were identified from CCAE, MDCD, MDCR, and Optum, with mean ages of 54.0, 61.6, 78.9, 70.0 years, respectively. In the 6 months prior to AIS, common comorbidities were hypertension, inflammation, hyperlipidemia, diabetes, heart and peripheral vascular disease. In the 30 days after AIS, 74.2-89.7% patients received no treatment of P2Y12i, aggrenox, warfarin, or DOACs, 6.9-16.2% received P2Y12i mono-treatment, 1.1-3.2% received aggrenox mono-treatment, 1.5-5.0% received warfarin mono-treatment, and 0.6-1.2% received DOACs mono-treatment.(Table) Among those receiving >1 treatment (0.2-0.8%), P2Y12i was the most common initial treatment, with warfarin as concurrent or subsequent treatment. (Figure)
Conclusions:
The large majority of patients do not receive P2Y12i, aggrenox, or anticoagulant treatment within 30 days after AIS. Among those treated, use of P2Y12i is the most common initial treatment. Future studies may evaluate outcomes associated with these treatments.
| CCAE | MDCD | MDCR | Optum | |||||
| N | % | N | % | N | % | N | % | |
| All | 122,317 | 100% | 77,979 | 100% | 127,046 | 100% | 172,415 | 100% |
| No P2Y12i, Aggrenox, warfarin, or DOACs | 90817 | 74.2% | 69974 | 89.7% | 99458 | 78.3% | 136192 | 79.0% |
| P2Y12i mono-treatment | 19805 | 16.2% | 5349 | 6.9% | 18009 | 14.2% | 25987 | 15.1% |
| Aggrenox mono-treatment | 3048 | 2.5% | 826 | 1.1% | 4090 | 3.2% | 3906 | 2.3% |
| Warfarin mono-treatment | 6174 | 5.0% | 1181 | 1.5% | 3437 | 2.7% | 4145 | 2.4% |
| DOACs mono-treatment | 1443 | 1.2% | 465 | 0.6% | 1177 | 0.9% | 1199 | 0.7% |
| More than 1 treatment | 1030 | 0.8% | 184 | 0.2% | 875 | 0.7% | 986 | 0.6% |
[Distribution of antithrombotic treatment patterns 30 days after hospitalized acute ischemic stroke without atrial fibrillation]
[Pathway analysis among patients receiving antithrombotic treatment 30 days after hospitalized acute ischemic stroke without atrial fibrillation.]
To cite this abstract in AMA style:
Wang L, Weaver J, Hardin J, Barnathan E, Foody J, Peters G, Yuan Z. Characterization and Antithrombotic Treatment of Patients with Acute Ischemic Stroke and No Atrial Fibrillation: A Real-world Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/characterization-and-antithrombotic-treatment-of-patients-with-acute-ischemic-stroke-and-no-atrial-fibrillation-a-real-world-study/. Accessed September 22, 2023.« Back to ISTH 2020 Congress
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