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

Morten Würtz, Morten Schmidt, Erik Lerkevang Grove, E. Puhó, Victor W. Henderson, Christian Fynbo Christiansen, Henrik Toft Sørensen

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)158-165
Number of pages8
JournalEuropean Heart Journal - Cardiovascular Pharmacotherapy
Volume4
Issue number3
DOIs
Publication statusPublished - Jul 1 2018

Fingerprint

clopidogrel
Platelet Aggregation Inhibitors
Aspirin
Cohort Studies
Stroke
Mortality
Cerebral Hemorrhage
Population
Subarachnoid Hemorrhage
Confidence Intervals
Denmark
Prescriptions
Registries
Hospitalization

Keywords

  • Antiplatelet therapy
  • Antithrombotic therapy
  • Epidemiology
  • Mortality
  • Pharmacology
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Pre-admission use of platelet inhibitors and short-term stroke mortality : A population-based cohort study. / Würtz, Morten; Schmidt, Morten; Grove, Erik Lerkevang; Puhó, E.; Henderson, Victor W.; Christiansen, Christian Fynbo; Sørensen, Henrik Toft.

In: European Heart Journal - Cardiovascular Pharmacotherapy, Vol. 4, No. 3, 01.07.2018, p. 158-165.

Research output: Contribution to journalArticle

Würtz, Morten ; Schmidt, Morten ; Grove, Erik Lerkevang ; Puhó, E. ; Henderson, Victor W. ; Christiansen, Christian Fynbo ; Sørensen, Henrik Toft. / Pre-admission use of platelet inhibitors and short-term stroke mortality : A population-based cohort study. In: European Heart Journal - Cardiovascular Pharmacotherapy. 2018 ; Vol. 4, No. 3. pp. 158-165.
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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.",
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T2 - A population-based cohort study

AU - Würtz, Morten

AU - Schmidt, Morten

AU - Grove, Erik Lerkevang

AU - Puhó, E.

AU - Henderson, Victor W.

AU - Christiansen, Christian Fynbo

AU - Sørensen, Henrik Toft

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N2 - 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.

AB - 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.

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KW - Antithrombotic therapy

KW - Epidemiology

KW - Mortality

KW - Pharmacology

KW - Stroke

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