title: Rapid change in prescribing behavior in hospitals participating in get with the guidelines-stroke after release of the management of atherothrombosis with clopidogrel in high-risk patients (MATCH) clinical trial results.
abstract: OBJECTIVE
  Physician prescribing patterns change slowly despite published randomized trials and consensus guidelines. We measure the effect of Management of Atherothrombosis With Clopidogrel in High-Risk Patients (MATCH) trial on discharge prescribing patterns for patients with stroke and those with transient ischemic attack in the Get With The Guidelines (GWTG)-Stroke Program.
  
  
  METHODS
  We analyzed discharge prescribing patterns of antithrombotic medications for patients admitted with ischemic stroke or transient ischemic attack at hospitals participating in GWTG-Stroke between October 2002 to January 2006. Clinical information by quarter was analyzed in relation to publication of the MATCH study. Frequency of discharge prescription of aspirin+clopidogrel post-MATCH publication was compared with the pre-MATCH period after adjusting for patient and hospital characteristics and clustering by hospital.
  
  
  RESULTS
  A total of 107 872 patients at 632 sites were eligible to receive antithrombotic therapy at discharge. Use of aspirin+clopidogrel therapy declined from 22.4% to 15.4% of patients after the publication of MATCH (adjusted OR 0.62, 95% CI 0.56 to 0.70, P<0.0001). Analysis by quarter revealed a rapid and sustained decrease in use of aspirin+clopidogrel therapy for the remainder of the study period.
  
  
  CONCLUSIONS
  A rapid and sustained reduction in the frequency of aspirin+clopidogrel use in ischemic stroke and transient ischemic attack was observed after publication of the MATCH trial in the absence of MATCH-specific GWTG-Stroke initiatives and preceding an American Heart Association guideline update.
authors.affiliation: University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada. bkmmenon@ucalgary.ca
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.forename: Michael R
authors.initials: MR
authors.lastname: Frankel
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Labresh
authors.forename: Gray
authors.initials: G
authors.lastname: Ellrodt
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D055656:Prescriptions; D020521:Stroke / Q000188:drug therapy*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin