@article{04f59d1e2f8c4988b2572c6a63415f51,
title = "Antithrombotic therapy for stroke prevention in patients with ischemic stroke with aspirin treatment failure",
abstract = "BACKGROUND AND PURPOSE: Many older patients presenting with acute ischemic stroke were already taking aspirin before admission. However, the management strategy for patients with aspirin treatment failure has not been fully established. METHODS: We used data from the American Heart Association Get With The Guidelines Stroke Registry to describe discharge antithrombotic treatment patterns among Medicare beneficiaries with ischemic stroke who were taking aspirin before their stroke and were discharged alive from 1734 hospitals in the United States between October 2012 and December 2017. RESULTS: Of 261634 ischemic stroke survivors, 100016 (38.2%) were taking aspirin monotherapy before stroke. Among them, 44.4% of patients remained on aspirin monotherapy at discharge (20.9% 81 mg, 18.2% 325 mg, 5.3% other or unknown dose). The next most common therapy choice was dual antiplatelet therapy (24.6%), followed by clopidogrel monotherapy (17.8%). The remaining 13.2% of patients were discharged on either aspirin/dipyridamole, warfarin, or nonvitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotic therapy at all. CONCLUSIONS: Nearly half of patients with ischemic stroke while on preventive therapy with aspirin are discharged on aspirin monotherapy without changing antithrombotic class, while the other half are discharged on clopidogrel monotherapy, dual antiplatelet therapy, or other less common agents. These findings emphasize the need for future research to identify best management strategies for this very common and complex clinical scenario.",
keywords = "Anticoagulants, Aspirin, Cardiovascular disease, Clopidogrel, Warfarin",
author = "Lusk, {Jay B.} and Haolin Xu and Peterson, {Eric D.} and Bhatt, {Deepak L.} and Fonarow, {Gregg C.} and Smith, {Eric E.} and Roland Matsouaka and Schwamm, {Lee H.} and Ying Xian",
note = "Funding Information: The Get With The Guidelines (GWTG)-Stroke program is provided by the American Heart Association/American Stroke Association. GWTG-Stroke is sponsored, in part, by Novartis, Boehringer Ingelheim Lilly, Novo Nordisk, Sanofi, AstraZeneca, Bayer, and Portola Pharmaceuticals. Research reported in this publication was supported by the National Institute On Aging of the National Institutes of Health under Award Number R01AG062770. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: The Get With The Guidelines (GWTG)-Stroke program is provided by the American Heart Association/American Stroke Association. GWTG-Stroke is sponsored, in part, by Novartis, Boehringer Ingelheim Lilly, Novo Nordisk, Sanofi, AstraZeneca, Bayer, and Portola Pharmaceuticals. Research reported in this publication was supported by the National Institute On Aging of the National Institutes of Health under Award Number R01AG062770. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: Dr Peterson discloses research Grant from Janssen, Genetech, Bristol Myers Squibb, American Heart Association and consultant/advisory Board: Janssen, Boehringer Ingelhiem, Sanofi, Bayer, Merck, Astra Zeneca, Signal Path, and Venable. Personal fees from Novartis. Dr Bhatt discloses the following relationships: Advisory Board for Boehringer Ingelheim, Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Janssen, Level Ex, Medscape Cardiology, MyoKardia, NirvaMed, Novo Nordisk, PhaseBio, PLx Pharma, Regado Biosciences, Stasys; Board of Directors for Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair for Inaugural Chair, American Heart Association Quality Oversight Committee; Data Monitoring Committees for Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Boston Scientific (Chair, PEITHO trial), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Novartis, Population Health Research Institute; honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Chair, ACC Accreditation Oversight Committee), Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), Cowen and Company, Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Piper Sandler, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today{\textquoteright}s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CSL Behring, Eisai, Ethicon, Faraday Pharmaceuticals, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Lexicon, Lilly, Medtronic, MyoKardia, NirvaMed, Novartis, Novo Nordisk, Owkin, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi, Stasys, Synaptic, The Medicines Company, 89Bio; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald{\textquoteright}s Heart Disease); site Co-Investigator for Abbott, Biotronik, Boston Scientific, CSI, St. Jude Medical (now Abbott), Philips, Svelte; Trustee: American College of Cardiology; Unfunded research from FlowCo, Merck, Takeda. Dr Fonarow reports grants from American Heart Association and grants from Patient Centered Outcome Research Institute outside the submitted work; and Employee of UC Regents that have a patent on an endovascular device. Dr Smith reports consulting fees from Bayer. Dr Schwamm reports work as a scientific consultant regarding trial design and conduct to Genentech (late window thrombolysis) and Member of steering committee (TIMELESS NCT03785678); consultant on user interface design and usability to LifeImage; member of a Data Safety Monitoring Boards (DSMB) for Penumbra (MIND NCT03342664) and for Diffusion Pharma (PHAST-TSC NCT03763929); Serving as National PI for Stroke AF, Medtronic (NCT02700945); National Co-PI, late window thrombolysis trial, NINDS (P50NS051343, MR WITNESS NCT01282242; and alteplase provided free of charge to Massachusetts General Hospital as well as supplemental per-patient payments to participating sites by Genentech); Site PI, StrokeNet Network NINDS (New England Regional Coordinating Center U24NS107243). Dr Xian discloses research support from National Institute on Aging R01AG062770, the American Heart Association, Genentech, Daiichi Sankyo, Janssen Pharmaceuticals; honoraria from Boehringer Ingelheim and Portola. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2021 American Heart Association, Inc.",
year = "2021",
month = dec,
day = "1",
doi = "10.1161/STROKEAHA.121.034622",
language = "English (US)",
volume = "52",
pages = "E777--E781",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "12",
}