Dual blood thinners under prescribed after minor or warning stroke, especially in women
- In a recent study, less than half of the people were prescribed dual blood-thinning therapy, despite evidence that starting two anti-platelet blood thinning medications, such as aspirin or clopidogrel, may reduce the short-term risk of recurrent stroke after a minor stroke or a transient ischemic attack (TIA) - also known as a warning stroke.
- In the analysis of medications prescribed to nearly 3,000 stroke survivors at discharge from stroke centers in Maryland, only 40% of patients were prescribed dual anti-platelet therapy, and women were significantly less likely to be prescribed two anti-platelet medications compared to men. This gender gap in treatment echoes under-treatment of women in other aspects of cardiovascular disease care.
- Increasing the use of dual anti-platelet therapy, particularly in women, may lead to a lower rate of stroke recurrence after a minor stroke or TIA.
Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023
DALLAS, Feb. 2, 2023 — Despite evidence that starting two blood-thinning medications shortly after a minor stroke or a warning stroke (transient ischemic attack - TIA) may prevent a second – possibly more serious – clot-caused stroke within a few months, the treatment regimen is underused especially among women, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.
Blood thinners, such as aspirin and clopidogrel, prevent platelets from sticking together and forming blood clots. Prescribing two anti-platelet medications at the same time is known as dual antiplatelet therapy (DAPT). In recent trials, DAPT has been shown to reduce the short-term risk of another stroke in people with a recent minor stroke (mild, non-disabling symptoms) or with a TIA. As with most strokes, a TIA is caused by a clot temporarily blocking blood flow to the brain, however, TIA symptoms usually only last a few minutes and result in no permanent brain injury or physical disability.
“All stroke survivors, regardless of sex, should receive optimal proven medications for stroke prevention including DAPT when medically appropriate,” said Jonathan Solomonow, M.D., lead author of the study and chief resident in neurology at the University of Maryland Medical Center in Baltimore.
To gauge how often DAPT was being prescribed when people with a minor stroke or TIA were discharged, the researchers reviewed the electronic health records of 2,953 adults admitted to one of the hospitals of the University of Maryland Stroke Clinical Network. The Maryland network includes nine stroke centers located in urban, suburban and rural hospitals serving a diverse population. All were treated for minor stroke or TIA between 2018 and 2021. None were taking blood thinning medication such as warfarin or apixaban before the stroke or TIA. The participants were average age 67 years; 42% were age 70 or older; 48% women, 37% Black adults and 60% white adults.
The analysis found:
- DAPT was underutilized across all hospitals reviewed, prescribed to just 40% of the overall patients.
- Men were more likely than women (43% vs. 37%, respectively) to be prescribed DAPT.
- The percentage of patients receiving DAPT did not differ significantly by race, age or whether the person was treated at a stroke center that delivers specialized stroke care.
“There are an increasing number of options available to prevent and reduce the risk of a recurrent stroke, including high blood pressure medications, statins to control cholesterol and dual blood thinners. Patients and their family members should inquire about the use of DAPT after a stroke or TIA to consider if DAPT may be beneficial,” Solomonow said.
The gender gap noted in the study could not be explained by differences in insurance coverage or in anticipated side effects of the medications, Solomonow added.
“The gender gap was not entirely surprising because there is extensive literature indicating that women with cardiovascular disease tend to be undertreated. For example, some studies show that women with heart disease or stroke are not prescribed statins as frequently as men. In addition, women with atrial fibrillation receive ablation less often than men,” Solomonow said. “Further research is needed to examine whether women are less likely to receive other proven therapies, such as statins for stroke prevention and anti-coagulation for atrial fibrillation.”
The study analyzed data from a single health system in Maryland, so the findings need to be confirmed in other settings including hospitals that are not certified stroke centers.
“Identifying systemic inequities is essential to improving patient care across all demographics. It would be useful for other centers to explore whether sex differences are present in other parts of the U.S. or health care systems in other countries,” Solomonow said.
Co-authors are Jamie R. Marks, Ph.D.; Karen L. Yarbrough, C.R.N.P.; Prachi Mehndiratta, M.B.B.S.; and Seemant Chaturvedi, M.D. Authors’ disclosures are listed in the abstract.
The study was funded by the department of neurology at the University of Maryland.
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- Abstracts on ASA’s International Stroke Conference 2023 Online Program Planner
- ·ASA news release: Risk of second stroke can be reduced with prevention efforts based on cause of first stroke (May 2021)
- ASA news release: One-month of dual anti-platelet therapy is safe and feasible after stent placement (Nov. 2020)
- ASA health information: Preventing another stroke
- For more news at ASA International Stroke Conference 2023, follow us on Twitter @HeartNews #ISC23
The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.
About the American Stroke Association
The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.
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