Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure.

Many older patients presenting with acute ischemic stroke were already taking aspirin prior to admission. However, the management strategy for patients with aspirin treatment failure has not been fully established. We used data from the American Heart Association Get With The Guidelines® (GWTG) Stroke Registry to describe discharge antithrombotic treatment patterns among Medicare beneficiaries with ischemic stroke who were taking aspirin prior to their stroke and were discharged alive from 1734 hospitals in the United States between October 2012 and December 2017. Of 261,634 ischemic stroke survivors, 100,016 (38.2%) were taking aspirin monotherapy prior to 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 DAPT (24.6%), followed by clopidogrel monotherapy (17.8%). The remaining 13.2% of patients were discharged on either aspirin/dipyridamole, warfarin or non-vitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotic therapy at all. 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, DAPT, 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.

许多出现急性缺血性脑卒中的老年患者在入院前已经在服用阿司匹林。然而，阿司匹林治疗失败患者的管理策略尚未完全确立。 我们使用美国心脏协会“遵循指南”（GWTG）脑卒中登记处的数据，描述了2012年10月至2017年12月期间在美国1734家医院中存活出院的、在脑卒中前服用阿司匹林的缺血性脑卒中医疗保险受益人出院时的抗血栓治疗模式。 在261634名缺血性脑卒中幸存者中，100016人（38.2%）在脑卒中前正在接受阿司匹林单一疗法。其中，44.4%的患者在出院时仍继续使用阿司匹林单一疗法（20.9%为81毫克，18.2%为325毫克，5.3%为其他或未知剂量）。接下来最常见的治疗选择是双联抗血小板治疗（DAPT，24.6%），其次是氯吡格雷单一疗法（17.8%）。其余13.2%的患者出院时使用的是阿司匹林/双嘧达莫、华法林或非维生素K拮抗剂口服抗凝剂（加用或不加用抗血小板药物），或者根本没有进行抗血栓治疗。 在接受阿司匹林预防性治疗的缺血性脑卒中患者中，近一半患者出院时继续使用阿司匹林单一疗法，未改变抗血栓类别，而另一半患者出院时使用氯吡格雷单一疗法、双联抗血小板治疗或其他不太常见的药物。这些发现强调了未来需要进行研究，以确定针对这种非常常见且复杂的临床情况的最佳管理策略。