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Clin Pharmacol Ther. 2019 Sep 10. doi: 10.1002/cpt.1625. [Epub ahead of print]

Secondary stroke prevention: a population-based cohort study on anticoagulation and antiplatelet treatments, and the risk of death or recurrence.

Author information

1
Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
2
Centre Régional de Pharmacovigilance de Paris, Hôpital Européen Georges Pompidou, Paris, France.
3
Département de Pharmacologie médicale, Université de Bordeaux, Bordeaux, France.
4
Center for Pharmacoepidemiology and Treatment Science, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.

Abstract

Using claims databases of a public healthcare program (Quebec) for the years 2010 - 2013, we conducted a cohort study of acute ischemic stroke (AIS) patients to describe secondary prevention treatments and determine how they stood against practice guidelines. We compared the risk of death or AIS recurrence over one year in patients treated with anticoagulants, antiplatelets and/or other cardiovascular drugs. In the month after discharge, 44.3% patients did not receive the recommended treatment and more than 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 (HR: 0.27; 95% CI 0.20-0.36 and HR: 0.25; 95% CI 0.16-0.38, respectively) compared to 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.

KEYWORDS:

Cardiovascular Disease; Comparative Effectiveness; Mortality; Pharmacoepidemiology; Platelets; Utilization

PMID:
31502245
DOI:
10.1002/cpt.1625

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