title: Discontinuation of antiplatelet treatment and risk of recurrent stroke and all-cause death: a cohort study.
abstract: BACKGROUND
  We wished to examine the impact of antiplatelet drug discontinuation on recurrent stroke and all-cause mortality.
  
  
  METHODS
  We identified a cohort of incident ischaemic stroke patients in a Danish stroke registry, 2007-2011. Using population-based registries we assessed subjects' drug use and followed them up for stroke recurrence, or all-cause death. Person-time was classified by antiplatelet drug use into current use, recent use (≤150 days after last use), and non-use (>150 days after last use). Lipid-lowering drug (LLD) use was classified by the same rules. We used Cox proportional hazard models to calculate the adjusted hazard ratio (HR) and corresponding 95% confidence intervals (CIs) for the risk of recurrent stroke or death associated with discontinuation of antiplatelet or LLD drugs.
  
  
  RESULTS
  Among 4,670 stroke patients followed up for up a median of 1.5 years, 237 experienced a second stroke and 600 died. Compared with current antiplatelet drug use, both recent use (1.3 (0.8-2.0)), and non-use (1.3 (0.8-1.9)) were associated with increased recurrent stroke risk. The corresponding HRs of death were 1.9 (1.4-2.5) for recent and 1.8 (1.4-2.3) for non-use of antiplatelet drugs. Recent statin use was associated with markedly increased risk of death (2.1 (1.7-2.6)), and only marginally with recurrent stroke (1.2 (0.9-1.6)).
  
  
  CONCLUSIONS
  Antiplatelet drug discontinuation may be associated with an increased recurrent stroke risk. Our results on death risk indicate that non-pharmacological biases, such as 'sick stopper', may threaten the validity of this risk estimate.
authors.affiliation: Department of Neurology, Odense University Hospital, Odense, Denmark.
authors.forename: Kamilla
authors.initials: K
authors.lastname: Ostergaard
authors.forename: Anton
authors.initials: A
authors.lastname: Pottegård
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
authors.forename: Søren
authors.initials: S
authors.lastname: Bak
authors.forename: René
authors.initials: R
authors.lastname: dePont Christensen
authors.forename: David
authors.initials: D
authors.lastname: Gaist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors