title: Trends in Ambulatory Prescribing of Antiplatelet Therapy among US Ischemic Stroke Patients: 2000-2007.
abstract: Objective. Study objectives were to assess temporal trends and identify patient- and practice-level predictors of the prescription of antiplatelet medications in a national sample of ischemic stroke (IS) patients seeking ambulatory care. Methods. IS-related outpatient visits by adults were identified using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey for the years 2000-2007. We assessed prescribing of antiplatelet medications using the generic drug code and drug entry codes in these data. Temporal trends in antiplatelet prescribing were assessed using the Cochran-Mantel-Haenszel test for trend. Results. We identified 9.5 million IS-related ambulatory visits. Antiplatelet medications were prescribed at 35.5% of visits. Physician office prescribing of the clopidogrel-aspirin combination increased significantly from 0.5% in 2000 to 22.0% in 2007 (P = 0.05), whereas prescribing of aspirin decreased from 17.9% to 7.0% (P = 0.50) during the same period. Conclusion. We observed a continued increase in prescription of the aspirin-clopidogrel combination from 2000 to 2007. Clinical trial evidence suggests that the aspirin-clopidogrel combination does not provide any additional benefit compared with clopidogrel alone; however, our study findings indicate that even with lack of adequate clinical evidence physician prescribing of this combination has increased in real-world community settings.
authors.affiliation: College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA ; RTI Health Solutions, Research Triangle Park, Durham, NC 27709, USA.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Karve
authors.forename: Deborah
authors.initials: D
authors.lastname: Levine
authors.forename: Eric
authors.initials: E
authors.lastname: Seiber
authors.forename: Milap
authors.initials: M
authors.lastname: Nahata
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan