title: Interruption to antiplatelet therapy early after acute ischaemic stroke: a nested case-control study.
abstract: OBJECTIVE
  Antiplatelet drugs are often discontinued early after ischaemic stroke, either because of poor compliance, complications or withdrawal of care. It is unclear whether this places patients at increased risk of recurrence. We explored the association between cardiovascular event rate and persistence with prescribed antiplatelet drugs.
  
  
  METHODS
  We used a matched case-control design using the Virtual International Stroke Trials Archive (VISTA). Cases were patients who had an acute coronary syndrome, recurrent stroke or transient ischaemic attack within 90 days post-stroke and were matched for age ± 10 years and sex with up to four controls. Antiplatelet use was categorized as persistent (used for >3 days and continued up to day 90), early cessation (used antiplatelet <3 days) or stopped/interrupted users (used for >3 days but stopped prior to day 90). These categories were compared in cases and controls using a conditional logistic regression model that adjusted for potential confounders.
  
  
  RESULTS
  A total of 970 patients were included, of whom 194 were cases and 776 were matched controls. At 90 days, 10 cases (5.2%) and 58 controls (7.5%) stopped/interrupted their antiplatelet. The risk of cardiovascular event was not different in stopped/interrupted users (adjusted odds ratio 0.70, 95% confidence interval 0.33, 1.48; P = 0.352) and early cessations (adjusted odds ratio 1.04, 95% confidence interval 0.62, 1.74; P = 0.876) when compared to persistent users.
  
  
  CONCLUSIONS
  We found no increased risk in patients who stopped and interrupted antiplatelets early after stroke but the study was limited by a small sample size and further research is needed.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.|Pharmacy Department, Serdang Hospital, 43000, Kajang, Selangor, Malaysia.
authors.forename: Wardati
authors.initials: W
authors.lastname: Mazlan-Kepli
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Macisaac
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Walters
authors.affiliation: Stroke Trials Unit, University of Nottingham, Nottingham, NG7 2UH, UK.
authors.forename: Philip Michael William
authors.initials: PMW
authors.lastname: Bath
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.
authors.forename: Jesse
authors.initials: J
authors.lastname: Dawson
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012008:Recurrence; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology*; D028761:Withholding Treatment / Q000706:statistics & numerical data*
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: acute ischaemic stroke; antiplatelet therapy; cardiovascular event