Antiplatelet prescribing patterns for TIA and ischemic stroke: the Indiana University experience.

OBJECTIVE

To evaluate antiplatelet prescribing patterns by Indiana University Hospital (IU) neurologists, determine what drives antiplatelet agent decisions, and determine changes made with recurrent cerebrovascular events despite proven antiplatelet therapy. There are now four approved therapies for secondary prevention of cerebrovascular events. As these agents exhibit their effects through different pathways, physicians must choose antiplatelet agents based on other factors.

DESIGN

We retrospectively reviewed charts of neurology patients diagnosed with non-fatal ischemic stroke or TIA at IU from January 1, 1997 to August 31, 2001. Patients were excluded if: discharge diagnosis was not non-fatal ischemic stroke or TIA, they were enrolled in clinical trials, or were placed on anticoagulation therapy with warfarin. Patients' antiplatelet agents at discharge were reviewed to determine if specific factors led to the choice of antiplatelet agent.

RESULTS

A total of 177 patients experienced non-fatal ischemic strokes or TIAs. Of these, 74 were not on prior antiplatelet therapy and 103 were on antiplatelet agents prior to admission. For patients not on therapy, aspirin was the most commonly prescribed agent, with a trend for low-dose aspirin. For patients already on an antiplatelet agent, typically the dose of aspirin was increased or combination therapy initiated.

CONCLUSION

Our experience supports the use of aspirin as a first-line agent for secondary prevention in cerebrovascular disease. For antiplatelet-nai;ve patients, low-dose aspirin is the most frequently used agent. For patients previously on antiplatelet agents, aspirin dosage is increased or clopidogrel is added. High-dose aspirin and ticlopidine use is no longer favored.