Pre-admission use of platelet inhibitors and short-term stroke mortality: a population-based cohort study

Eur Heart J Cardiovasc Pharmacother. 2018 Jul 1;4(3):158-165. doi: 10.1093/ehjcvp/pvy010.

Abstract

Aims: The impact of pre-admission antiplatelet treatment on prognosis after stroke is poorly understood. We, therefore, investigated whether pre-admission use of aspirin and clopidogrel was associated with mortality in patients hospitalized with ischaemic stroke, intracerebral haemorrhage (ICH), or subarachnoid haemorrhage (SAH).

Methods and results: We used nationwide population-based registries to identify all first-time hospitalizations for stroke and subsequent mortality in patients treated with aspirin and clopidogrel in Denmark during 2004-2012. Based on redeemed prescriptions, we computed absolute 30-day mortality rates and mortality rate ratios (MRRs) for current platelet inhibitor users and non-users. We used Cox regression to control for potentially confounding factors. Among platelet inhibitor non-users, 30-day stroke mortality was 12.0% (8.8% for ischaemic stroke, 29.6% for ICH, and 21.2% for SAH). Compared with non-users, the adjusted 30-day MRR (aMRR) was increased among ICH patients using aspirin [1.19, 95% confidence interval (CI) 1.09-1.31]. Although wider CIs, similar increased point estimates were observed in users of both aspirin and clopidogrel (aMRR = 1.26, 95% CI 0.84-1.91). In contrast, current use of both aspirin and clopidogrel was associated with reduced mortality from ischaemic stroke (aMRR = 0.67, 95% CI 0.48-0.94), while use of aspirin alone was not.

Conclusion: Among patients hospitalized for first-time ICH, pre-admission platelet inhibitor use was associated with increased 30-day mortality compared with non-use. In patients hospitalized for ischaemic stroke, 30-day mortality was reduced in users of both aspirin and clopidogrel, but not in users of aspirin alone.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aspirin / administration & dosage*
  • Aspirin / adverse effects
  • Brain Ischemia / diagnosis
  • Brain Ischemia / mortality*
  • Brain Ischemia / prevention & control
  • Cerebral Hemorrhage / diagnosis
  • Cerebral Hemorrhage / mortality*
  • Clopidogrel / administration & dosage*
  • Denmark / epidemiology
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Admission*
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Platelet Aggregation Inhibitors / adverse effects
  • Prognosis
  • Protective Factors
  • Registries
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / mortality*
  • Stroke / prevention & control
  • Subarachnoid Hemorrhage / diagnosis
  • Subarachnoid Hemorrhage / mortality*
  • Time Factors

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Aspirin