Prescription of Antithrombotic Therapy in Older Patients Hospitalized for Transient Ischemic Attack and Ischemic Stroke: The GIFA Study

Volpato, Stefano; Maraldi, Cinzia; Blé, Alessandro; Ranzini, Monica; Atti, Anna Rita; Lj, Dominguez; Barbagallo, Mario; Fellin, Renato; Zuliani, Giovanni

doi:10.1161/01.str.0000121648.74433.b5

Cited by 36 publications

(29 citation statements)

References 33 publications

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“…11 Also, in an Italian study of hospitalized TIA and ischemic stroke patients, more than 40% were discharged without any antithrombotic medication. 26 We also found that patients who were given aspirin in our study were less likely to be admitted (OR, 0.2). Although our data do not allow us to know the reason for this, we speculate that physicians who discharged TIA patients felt a need to ''do something,'' and thus prescribed aspirin.…”

Section: Discussionsupporting

confidence: 61%

“…2 Both the AHA 18-21 and NSA 22 have disseminated guidelines for the approach to TIA patients. Because compliance with these recommendations is highly variable, 11,[23][24][25][26] we studied this issue in TIA patients seen in U.S. EDs. We focused on three elements: use of brain imaging, administration of antiplatelet agents, and hospitalization rates.…”

Section: Discussionmentioning

confidence: 99%

“…4,19,20,22 Nevertheless, the published medical literature continues to show a great deal of variability in physicians' compliance with these guidelines. 11,23,24,26 …”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21][22] However, many reports document enormous variability in how often physicians follow these recommendations. 11,[23][24][25][26] The purpose of our study was to describe the epidemiology of emergency department (ED) visits for TIA and to investigate trends in diagnostic imaging, therapeutic interventions, and hospital admission rates during a tenyear period. Specifically, we measured emergency physician compliance with 1) use of antiplatelet therapy, 2) use of neuroimaging, and 3) hospitalization rates.…”

mentioning

confidence: 99%

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National Study on Emergency Department Visits for Transient Ischemic Attack, 1992–2001

Edlow

Kim

Pelletier

et al. 2006

Academic Emergency Medicine

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Objectives: To describe the epidemiology of U.S. emergency department (ED) visits for transient ischemic attack (TIA) and to measure rates of antiplatelet medication use, neuroimaging, and hospitalization during a ten-year time period.Methods: The authors obtained data from the 1992-2001 National Hospital Ambulatory Medical Care Survey. TIA cases were identified by having ICD-9 code 435.Results: From 1992 to 2001, there were 769 cases, representing 2,969,000 ED visits for TIA. The population rate of 1.1 ED visits per 1,000 U.S. population (95% CI = 0.92 to 1.30) was stable over time. TIA was diagnosed in 0.3% of all ED visits. Physicians administered aspirin and other antiplatelet agents to a small percentage of patients, and 42% of TIA patients (95% CI = 29% to 55%) received no medications at all in the ED. Too few data points existed to measure a statistically valid trend over time. Physicians performed computed tomography scanning in 56% (95% CI = 45% to 66%) of cases and performed magnetic resonance imaging (MRI) in <5% of cases, and there was a trend toward increased imaging over time. Admission rates did not increase during the ten-year period, with 54% (95% CI = 42% to 67%) admitted. Regional differences were noted, however, with the highest admission rate found in the Northeast (68%).Conclusions: Between 1992 and 2001, the population rate of ED visits for TIA was stable, as were admission rates (54%). Antiplatelet medications appear to be underutilized and to be discordant with published guidelines. Neuroimaging increased significantly. These findings may reflect the limited evidence base for the guidelines, educational deficits, or other barriers to guideline implementation.ACADEMIC EMERGENCY MEDICINE 2006; 13:666-672 ª

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

“…4,19,20,22 Nevertheless, the published medical literature continues to show a great deal of variability in physicians' compliance with these guidelines. 11,23,24,26 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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National Study on Emergency Department Visits for Transient Ischemic Attack, 1992–2001

Edlow

Kim

Pelletier

et al. 2006

Academic Emergency Medicine

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“…In line with the results of our study, Volpato et al (23) found a considerably high rate (more than 40 %) of patients with acute ischemic stroke or TIA without prescription of antithrombotic therapy at hospital discharge. In a cross-sectional survey carried out by Filippi et al (11), in family practice more than one quarter of patients with a history of stroke or TIA were not treated with antithrombotic agents.…”

Section: Tab 2 the Univariate Analysis Of The Infl Uence Of Patientsupporting

confidence: 93%

The use of antiplatelet medication in hospitalised elderly patients

Wawruch¹,

Slezakova²,

Murı́n³

et al. 2015

BLL

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BACKGROUND: The use of antiplatelet agents is strongly recommended for the secondary prevention of ischemic events such as myocardial infarction, stroke/transient ischemic attack (TIA). OBJECTIVES: The aim of our study was to analyse the use of antiplatelet medication in patients after myocardial infarction, stroke/TIA, and patients with both conditions and to identify patient-related characteristics, which determine the use of such drugs in elderly patients. METHODS: Study sample (n = 372) was derived from 2,157 patients admitted to long-term care departments of three municipal hospitals. The study included patients aged ≥65 years after myocardial infarction, stroke/TIA or both. RESULTS: Antiplatelet medications were prescribed in 54.8 % and 68.5 % of patients at hospital admission and discharge, respectively. Hospitalisation led to a signifi cant increase in the use of antiplatelet medication in patients after myocardial infarction and in those with the combination of both events. However, in patients after only stroke/TIA, we did not fi nd any signifi cant difference comparing the use of antiplatelet medication at the time of hospital admission and discharge, respectively. CONCLUSION: Our study revealed that physicians are more aware of the benefi ts of antiplatelet medication in elderly patients after myocardial infarction or those after both myocardial infarction and stroke/TIA in comparison with patients after only stroke/TIA (Tab. 3, Ref. 32). Text in PDF www.elis.sk.

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Secondary Stroke Prevention: A Population‐Based Cohort Study on Anticoagulation and Antiplatelet Treatments, and the Risk of Death or Recurrence

Faure

Castilloux

Lillo‐Lelouet

et al. 2019

Clin Pharma and Therapeutics

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Using claims databases of a public healthcare program (Quebec) for the years 2010–2013, we conducted a cohort study of patients with acute ischemic stroke (AIS) to describe secondary prevention treatments and determine how they stood against practice guidelines. We compared the risk of death or AIS recurrence over 1 year in patients treated with anticoagulants, antiplatelets, and/or other cardiovascular drugs. In the month after discharge, 44.3% of the patients did not receive the recommended treatment and > 20% did not have any treatment. Untreated patients were younger, had less comorbidities, and a more severe AIS. Anticoagulants and antiplatelets were associated with a reduced risk of death or recurrence (hazard ratio (HR) 0.27; 95% confidence interval (CI) 0.20–0.36 and HR 0.25; 95% CI 0.16–0.38, respectively) compared with the untreated group. Effect size was similar for the other treatments. Findings confirm treatment benefits shown in clinical trials and emphasize the importance of AIS secondary prevention.

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Prescription of Antithrombotic Therapy in Older Patients Hospitalized for Transient Ischemic Attack and Ischemic Stroke: The GIFA Study

Cited by 36 publications

References 33 publications

National Study on Emergency Department Visits for Transient Ischemic Attack, 1992–2001

National Study on Emergency Department Visits for Transient Ischemic Attack, 1992–2001

The use of antiplatelet medication in hospitalised elderly patients

Secondary Stroke Prevention: A Population‐Based Cohort Study on Anticoagulation and Antiplatelet Treatments, and the Risk of Death or Recurrence

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