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Anti-Platelet Use Reduces Stroke Severity and Improves Outcomes in Patients With No History of Ischemic Events: Presented at ISC

By Cameron Johnston

KISSIMMEE, FL -- February 20, 2006 -- It is well known that the use of aspirin and other anti-platelet therapies reduces the risk of recurrent stroke and ischemic events. Now, a study presented here recently at the International Stroke Conference (ISC) has reported that people who use anti-platelet therapies prior to having a stroke also have significantly better outcomes compared with those who do not use them.

According to Nerses Sanossian, MD, Stroke Neurologist, Department of Stroke Neurology, University of California at Los Angeles Stroke Center, Los Angeles, California, United States, the findings seem to apply to all anti-platelet medications, not just aspirin.

Dr. Sanossian and colleagues conducted a review of 260 patients, of whom 92 had been taking some form of anti-platelet, 142 who were using no anti-platelet therapy and 26 who were using warfarin alone.

Of those who were taking anti-platelets, 68 were taking aspirin alone, 5 were taking clopidogrel alone, 11 were taking aspirin with clopidogrel, 1 was taking clopidogrel with warfarin, 5 were taking aspirin with extended release dipyridamole, 1 was taking aspirin with short-acting dipyridamole and 1 was taking ticlopidine alone.

Patients were matched for baseline characteristics. The only major difference in baseline factors between the groups was that more patients who had had prior myocardial infarctions (MI), strokes or transient ischemic attacks (TIAs) were already taking some form of antiplatelet therapy.

After a mean of 16 months of follow-up, patients who had been using antiplatelet therapy had a significantly lower mean National Institute of Health Stroke Scale (NIHSS) scores at hospital admission for stroke compared with patients who had not been taking antiplatelet agents (4.5 vs. 7.0, P = .005).

However, this finding was only true among patients who had not had any kind of prior stroke or TIA. NIHSS scores were 4.8 and 8.0 among antiplatelet users and non-users, respectively (P = .03) who had no history of prior ischemic event. Conversely, there was no meaningful NIHSS score difference among patients who had had a prior event depending on whether they had been using an antiplatelet drug or not (4.91 vs. 4.86, respectively).

The likelihood of having a good outcome defined as a modified Rankin Score (mRS) of 0-1 was more than doubled for patients who had been taking antiplatelet therapy (Odds Ratio 2.1, P = .007). There was a trend toward better outcomes among males (OR = 1.54, P = .104), and as expected, the risk of a poor mRS outcome was reduced in older patients, and if they had a cardioembolic or large vessel event.

Dr. Sanossian pointed out that there were no clinically important differences between patients who had been taking multiple antiplatelets compared with those who had been taking a single agent, with median NIHSS scores of 5 and 4, respectively.

On the basis of these data, Dr. Sanossian said it appears that antiplatelet therapies are underutilized. Even if the NIHSS scores and mRS outcomes did not reflect a benefit to taking antiplatelet among patients who had a history of prior ischemic events, past research has shown that these agents use greatly reduce the risk of a subsequent events.

These data also demonstrate that antiplatelet use can contribute to a less severe stroke in those with no history of prior event, and that the likelihood of a good outcome will be improved at discharge if the patient is using prophylactic antiplatelets.


[Presentation title: Antiplatelet Use Is Associated with Less Severe Stroke in Patients With No Prior History of Stroke or TIA. Abstract 32]

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