Abstract WP7: Utilization and Outcomes Associated With DAPT and ASA Monotherapy Amongst Hospitalizations With Large Vessel Occlusion: A Nationwide Cross-Sectional Analysis

Abstract

Background: In clinical trials like SPS3, MATCH, CHANCE, and POINT, dual antiplatelet treatment (DAPT) has been compared to aspirin (ASA) alone for preventing symptomatic large vessel occlusion (LVO) and ischemic strokes. Based on the effect size in the aforementioned studies, nationwide research may provide a more complete assessment of outcomes and relationships and help fill knowledge gaps. We used a nationwide inpatient sample to evaluate the outcomes of symptomatic LVO among patients using DAPT versus ASA monotherapy. Methods: We performed a cross-sectional study of a nationwide inpatient sample (2003-2014) in adult LVO hospitalizations. The patients taking DAPT and ASA on admission were identified using ICD-9-CM code. The univariate analysis (chi-square test) and multivariable survey logistic regression analyses were performed to compare mortality, morbidity, discharge (home vs transfer to short-term hospital, skilled nursing facility, and home health care), and disability to calculate odds ratio with 95% CI using SAS 9.4. Results: Of 4,224,924 hospitalizations, 1.24% and 7.38% were on DAPT and ASA, respectively. In comparison to ASA monotherapy, DAPT users were associated with lower prevalence of mortality (2.2% vs 3.1%) and morbidity (3.8% vs 3.9%) with similar prevalence of discharge to the non-home (58.8% vs 58.8%), (p<0.0001). On weighted analysis, use of DAPT vs. ASA was associated with lower odds of mortality (DAPT: OR 0.45; 95%CI 0.39-0.51; ASA: 0.61, 0.58-0.64), morbidity (DAPT: 0.54, 0.49-0.61, ASA: 0.56, 0.54-0.59), discharge to non-home (DAPT: 0.78, 0.75-0.82, ASA: 0.80, 0.79-0.82), and disability (DAPT: 0.76, 0.73-0.80, ASA: 0.80, 0.78-0.82) compared to non-users. Conclusion: This comprehensive national investigation revealed that DAPT resulted in more favorable outcomes for individuals with symptomatic large vessel occlusion. There is a need for additional prospective studies to validate the findings and ascertain the most suitable population at risk for primary prevention of stroke.