Abstract
IntroductionRecent trials report positive results for preventing vascular events with dual antiplatelet therapy (DAPT) in patients with high-risk TIA or minor ischemic stroke. We aimed to investigate this population regarding influence of age on vascular risk factors, hospital stay and mortality.Patients and methodsData on patients aged 40–100 years with TIA or ischemic stroke in the Swedish Stroke Register during 2012–13 were linked with national registers. To identify patients with high-risk TIA (ABCD2 ≥6) or minor ischemic stroke (NIHSS ≤5) eligible for DAPT, we excluded patients with atrial fibrillation, anticoagulant use, prior major bleeding, or unknown stroke severity.FindingsWe identified 10,053 potential DAPT-candidates (mean age 72.6 years, 45.2% female, 16.4% with TIA). With advancing age, most vascular risk factors increased. Antiplatelet treatment increased from 31.9% before the event to 95.5% after discharge. Within 1 year following index event, the proportion of patients with ≥1 re-admission increased with age (29.2% in 40–64 year-olds; 47.2% in 85–100 year-olds). All-cause death per 100 person-years was 6.9 (95% CI 6.4–7.4) within 1 year, and highest in the first 30 days (15.2; 95% CI 12.8–18.2). For each year of increased age, the risk of death increased with 3.5% (p = 0.128) in patients 40–64 years and with 11.8% (p < 0.001) in those ≥85 years.ConclusionsWhile in theory representing a subset of patients with mild injury, our observational study highlights substantial use of health-care resources and high mortality rates among patients with high-risk TIA or minor ischemic stroke assumed eligible for DAPT.
Highlights
Recent trials report positive results for preventing vascular events with dual antiplatelet therapy (DAPT) in patients with high-risk transient ischemic attack (TIA) or minor ischemic stroke
Cerebrovascular ischemic events, such as transient ischemic attack (TIA) or acute ischemic stroke (AIS), can have a wide range of presentations, from transient symptoms to large infarctions resulting in major disability and/or death
For patients with high-risk TIA and minor AIS, recent trials report positive results for dual antiplatelet therapy (DAPT) with aspirin and P2Y12-inhibitors,[9,10,11] and short-term DAPT with aspirin and clopidogrel is recommended in guidelines.[12,13]
Summary
Recent trials report positive results for preventing vascular events with dual antiplatelet therapy (DAPT) in patients with high-risk TIA or minor ischemic stroke. Stroke is a leading cause of disability and death worldwide, with an estimated yearly cost of e60 billion in Europe (2017).[1] Despite a decrease in the agestandardized incidence over time, the overall burden of stroke remains high as the population ages.[2]. Cerebrovascular ischemic events, such as transient ischemic attack (TIA) or acute ischemic stroke (AIS), can have a wide range of presentations, from transient symptoms to large infarctions resulting in major disability and/or death. Despite increased evidence and stronger recommendations for DAPT in secondary stroke prevention, limited realworld data on the targeted population are so far presented.[7,14,15]
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