title: Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke.
abstract: Antithrombotics are the mainstay of treatment in primary and secondary prevention of stroke, and their use before an acute event may be associated with better outcomes.
  
  
  
  Using data from Get With The Guidelines-Stroke with over half a million acute ischemic strokes recorded between October 2011 and March 2014 (n=540 993) from 1661 hospitals across the United States, we examined the unadjusted and adjusted associations between previous antithrombotic use and clinical outcomes.
  
  
  
  There were 250 104 (46%) stroke patients not receiving any antithrombotic before stroke; of whom approximately one third had a documented previous vascular indication. After controlling for clinical and hospital factors, patients who were receiving antithrombotics before stroke had better outcomes than those who did not, regardless of whether a previous vascular indication was present or not: adjusted odds ratio (95% confidence intervals) were 0.82 (0.80-0.84) for in-hospital mortality, 1.18 (1.16-1.19) for home as the discharge destination, 1.15 (1.13-1.16) for independent ambulatory status at discharge, and 1.15 (1.12-1.17) for discharge modified Rankin Scale score of 0 or 1.
  
  
  
  Previous antithrombotic therapy was independently associated with improved clinical outcomes after acute ischemic stroke. Ensuring the use of antithrombotics in appropriate patient populations may be associated with benefits beyond stroke prevention.
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.). phyo.myint@abdn.ac.uk.
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Reeves
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Robert E
authors.initials: RE
authors.lastname: Suter
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D020521:Stroke / Q000188:drug therapy / Q000401:mortality*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: antiplatelet agents; antithrombotic agents; mortality; prognosis; stroke