Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke

Phyo K. Myint; Anne S.  Hellkamp; Gregg C.  Fonarow; Matthew J. Reeves; Lee H. Schwamm; Phillip J. Schulte; Ying Xian; Robert E. Suter; Deepak L. Bhatt; Jeffrey L. Saver; Eric D. Peterson; Eric E. Smith

doi:10.1161/STROKEAHA.115.012414

Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke

Phyo K. Myint^* (Corresponding Author), Anne S. Hellkamp, Gregg C. Fonarow, Matthew J. Reeves, Lee H. Schwamm, Phillip J. Schulte, Ying Xian, Robert E. Suter, Deepak L. Bhatt, Jeffrey L. Saver, Eric D. Peterson, Eric E. Smith

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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Abstract

Background and Purpose—Antithrombotics are the mainstay of treatment in primary and secondary prevention of stroke, and their use before an acute event may be associated with better outcomes.

Methods—Using data from Get With The Guidelines-Stroke with over half a million acute ischemic strokes recorded between October 2011 and March 2014 (n=540 993) from 1661 hospitals across the United States, we examined the unadjusted and adjusted associations between previous antithrombotic use and clinical outcomes.

Results—There were 250 104 (46%) stroke patients not receiving any antithrombotic before stroke; of whom approximately one third had a documented previous vascular indication. After controlling for clinical and hospital factors, patients who were receiving antithrombotics before stroke had better outcomes than those who did not, regardless of whether a previous vascular indication was present or not: adjusted odds ratio (95% confidence intervals) were 0.82 (0.80–0.84) for in-hospital mortality, 1.18 (1.16–1.19) for home as the discharge destination, 1.15 (1.13–1.16) for independent ambulatory status at discharge, and 1.15 (1.12–1.17) for discharge modified Rankin Scale score of 0 or 1.

Conclusions—Previous antithrombotic therapy was independently associated with improved clinical outcomes after acute ischemic stroke. Ensuring the use of antithrombotics in appropriate patient populations may be associated with benefits beyond stroke prevention.

Original language	English
Pages (from-to)	2066-2074
Number of pages	9
Journal	Stroke
Volume	47
Issue number	8
Early online date	19 Jul 2016
DOIs	https://doi.org/10.1161/STROKEAHA.115.012414
Publication status	Published - 1 Aug 2016

Bibliographical note

Acknowledgments

Drs Myint and Smith conceived the idea and developed the analysis plan with critical input from coauthors. A.S. Hellkamp analyzed the data. Drs Myint and Smith drafted the article with input from all coauthors. All authors contributed in interpretation of results and in making an important intellectual contribution to the article.

Sources of Funding

The Get With The Guidelines (GWTG)-Stroke program is currently supported, in part, by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in design or analysis, article preparation, or approval of this study.

Keywords

mortality
prognosis
stroke
antiplatelet agents
antithrombotic agents

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Phyo Myint, Clinical Chair in Medicine of Old Age
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Old Age Medicine (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic

Cite this

Myint, P. K., Hellkamp, A. S., Fonarow, G. C., Reeves, M. J., Schwamm, L. H., Schulte, P. J., Xian, Y., Suter, R. E., Bhatt, D. L., Saver, J. L., Peterson, E. D., & Smith, E. E. (2016). Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke. Stroke, 47(8), 2066-2074. https://doi.org/10.1161/STROKEAHA.115.012414

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abstract = "Background and Purpose—Antithrombotics are the mainstay of treatment in primary and secondary prevention of stroke, and their use before an acute event may be associated with better outcomes.Methods—Using data from Get With The Guidelines-Stroke with over half a million acute ischemic strokes recorded between October 2011 and March 2014 (n=540 993) from 1661 hospitals across the United States, we examined the unadjusted and adjusted associations between previous antithrombotic use and clinical outcomes.Results—There were 250 104 (46%) stroke patients not receiving any antithrombotic before stroke; of whom approximately one third had a documented previous vascular indication. After controlling for clinical and hospital factors, patients who were receiving antithrombotics before stroke had better outcomes than those who did not, regardless of whether a previous vascular indication was present or not: adjusted odds ratio (95% confidence intervals) were 0.82 (0.80–0.84) for in-hospital mortality, 1.18 (1.16–1.19) for home as the discharge destination, 1.15 (1.13–1.16) for independent ambulatory status at discharge, and 1.15 (1.12–1.17) for discharge modified Rankin Scale score of 0 or 1.Conclusions—Previous antithrombotic therapy was independently associated with improved clinical outcomes after acute ischemic stroke. Ensuring the use of antithrombotics in appropriate patient populations may be associated with benefits beyond stroke prevention.",

keywords = "mortality, prognosis, stroke, antiplatelet agents, antithrombotic agents",

author = "Myint, {Phyo K.} and Hellkamp, {Anne S.} and Fonarow, {Gregg C.} and Reeves, {Matthew J.} and Schwamm, {Lee H.} and Schulte, {Phillip J.} and Ying Xian and Suter, {Robert E.} and Bhatt, {Deepak L.} and Saver, {Jeffrey L.} and Peterson, {Eric D.} and Smith, {Eric E.}",

note = "Acknowledgments Drs Myint and Smith conceived the idea and developed the analysis plan with critical input from coauthors. A.S. Hellkamp analyzed the data. Drs Myint and Smith drafted the article with input from all coauthors. All authors contributed in interpretation of results and in making an important intellectual contribution to the article. Sources of Funding The Get With The Guidelines (GWTG)-Stroke program is currently supported, in part, by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in design or analysis, article preparation, or approval of this study.",

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doi = "10.1161/STROKEAHA.115.012414",

language = "English",

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T1 - Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke

AU - Myint, Phyo K.

AU - Hellkamp, Anne S.

AU - Fonarow, Gregg C.

AU - Reeves, Matthew J.

AU - Schwamm, Lee H.

AU - Schulte, Phillip J.

AU - Xian, Ying

AU - Suter, Robert E.

AU - Bhatt, Deepak L.

AU - Saver, Jeffrey L.

AU - Peterson, Eric D.

AU - Smith, Eric E.

N1 - Acknowledgments Drs Myint and Smith conceived the idea and developed the analysis plan with critical input from coauthors. A.S. Hellkamp analyzed the data. Drs Myint and Smith drafted the article with input from all coauthors. All authors contributed in interpretation of results and in making an important intellectual contribution to the article. Sources of Funding The Get With The Guidelines (GWTG)-Stroke program is currently supported, in part, by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in design or analysis, article preparation, or approval of this study.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background and Purpose—Antithrombotics are the mainstay of treatment in primary and secondary prevention of stroke, and their use before an acute event may be associated with better outcomes.Methods—Using data from Get With The Guidelines-Stroke with over half a million acute ischemic strokes recorded between October 2011 and March 2014 (n=540 993) from 1661 hospitals across the United States, we examined the unadjusted and adjusted associations between previous antithrombotic use and clinical outcomes.Results—There were 250 104 (46%) stroke patients not receiving any antithrombotic before stroke; of whom approximately one third had a documented previous vascular indication. After controlling for clinical and hospital factors, patients who were receiving antithrombotics before stroke had better outcomes than those who did not, regardless of whether a previous vascular indication was present or not: adjusted odds ratio (95% confidence intervals) were 0.82 (0.80–0.84) for in-hospital mortality, 1.18 (1.16–1.19) for home as the discharge destination, 1.15 (1.13–1.16) for independent ambulatory status at discharge, and 1.15 (1.12–1.17) for discharge modified Rankin Scale score of 0 or 1.Conclusions—Previous antithrombotic therapy was independently associated with improved clinical outcomes after acute ischemic stroke. Ensuring the use of antithrombotics in appropriate patient populations may be associated with benefits beyond stroke prevention.

AB - Background and Purpose—Antithrombotics are the mainstay of treatment in primary and secondary prevention of stroke, and their use before an acute event may be associated with better outcomes.Methods—Using data from Get With The Guidelines-Stroke with over half a million acute ischemic strokes recorded between October 2011 and March 2014 (n=540 993) from 1661 hospitals across the United States, we examined the unadjusted and adjusted associations between previous antithrombotic use and clinical outcomes.Results—There were 250 104 (46%) stroke patients not receiving any antithrombotic before stroke; of whom approximately one third had a documented previous vascular indication. After controlling for clinical and hospital factors, patients who were receiving antithrombotics before stroke had better outcomes than those who did not, regardless of whether a previous vascular indication was present or not: adjusted odds ratio (95% confidence intervals) were 0.82 (0.80–0.84) for in-hospital mortality, 1.18 (1.16–1.19) for home as the discharge destination, 1.15 (1.13–1.16) for independent ambulatory status at discharge, and 1.15 (1.12–1.17) for discharge modified Rankin Scale score of 0 or 1.Conclusions—Previous antithrombotic therapy was independently associated with improved clinical outcomes after acute ischemic stroke. Ensuring the use of antithrombotics in appropriate patient populations may be associated with benefits beyond stroke prevention.

KW - mortality

KW - prognosis

KW - stroke

KW - antiplatelet agents

KW - antithrombotic agents

U2 - 10.1161/STROKEAHA.115.012414

DO - 10.1161/STROKEAHA.115.012414

M3 - Article

SN - 0039-2499

VL - 47

SP - 2066

EP - 2074

JO - Stroke

JF - Stroke

IS - 8

ER -

Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke

Abstract

Bibliographical note

Keywords

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Phyo Myint, Clinical Chair in Medicine of Old Age

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