307 An audit of dual antiplatelet prescribing after minor ischaemic stroke

Abstract

Abstract Background The American Heart Association make class 1A recommendation for dual antiplatelet therapy for secondary prevention in patients with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤ 3) or high risk TIA on the basis of evidence from randomised controlled trials, such as POINT and CHANCE, which have demonstrated a lower rate of subsequent stroke compared with single antiplatelet therapy. A number of clinical factors have been shown to influence effectiveness, including time from symptom onset to initiation of dual antiplatelet therapy. We aim to evaluate the rate of dual antiplatelet prescribing in this cohort and whether the rationale not to prescribe was clearly documented. Methods We reviewed the electronic records of all stroke patients aged 18 and above, admitted to University Hospital Galway within June 1st to September 29th 2022. Patients who either had a minor ischaemic stroke with a clearly documented NIHSS score of ≤3 were included in the analysis. These records were then assessed for the rate of dual antiplatelet prescribing versus single antiplatelet prescribing and if the rationale was documented. Results Of 29 patients admitted with minor ischaemic stroke, 8 were commenced on dual antiplatelet therapy. The mean number of days from symptom onset to presentation was 1.92 for those who were prescribed DAPT and 2.42 for those who were prescribed SAPT. Of those prescribed SAPT, the rationale for not commencing DAPT was documented. Rationale included delay to presentation (>72 hours) and atrial fibrillation. Conclusion 48.3% (n = 14) DAPT was either prescribed or a documented rationale for SAPT was provided. Our findings are consistent with DAPT prescribing patterns in other studies [1].