Discontinuation of antiplatelet treatment and risk of recurrent stroke and all-cause death: a cohort study

Research output: Contribution to journalJournal articleResearchpeer-review

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. © 2014 S. Karger AG, Basel.

Original languageEnglish
JournalNeuroepidemiology
Volume43
Issue number1
Pages (from-to)57-64
ISSN0251-5350
Publication statusPublished - 2014

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Cause of Death
Cohort Studies
Platelet Aggregation Inhibitors
Pharmaceutical Preparations
Registries
Lipids
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Proportional Hazards Models
Confidence Intervals
Population

Cite this

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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. {\circledC} 2014 S. Karger AG, Basel.",
author = "Kamilla Ostergaard and Anton Potteg{\aa}rd and Jesper Hallas and S{\o}ren Bak and {dePont Christensen}, Ren{\'e} and David Gaist",
year = "2014",
language = "English",
volume = "43",
pages = "57--64",
journal = "Neuroepidemiology",
issn = "0251-5350",
publisher = "S. Karger AG",
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Discontinuation of antiplatelet treatment and risk of recurrent stroke and all-cause death : a cohort study. / Ostergaard, Kamilla; Pottegård, Anton; Hallas, Jesper; Bak, Søren; dePont Christensen, René; Gaist, David.

In: Neuroepidemiology, Vol. 43, No. 1, 2014, p. 57-64.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Discontinuation of antiplatelet treatment and risk of recurrent stroke and all-cause death

T2 - a cohort study

AU - Ostergaard, Kamilla

AU - Pottegård, Anton

AU - Hallas, Jesper

AU - Bak, Søren

AU - dePont Christensen, René

AU - Gaist, David

PY - 2014

Y1 - 2014

N2 - 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. © 2014 S. Karger AG, Basel.

AB - 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. © 2014 S. Karger AG, Basel.

M3 - Journal article

C2 - 25323533

VL - 43

SP - 57

EP - 64

JO - Neuroepidemiology

JF - Neuroepidemiology

SN - 0251-5350

IS - 1

ER -