Pre- and post-stroke oral antithrombotics and mortality in patients with ischaemic stroke

Background: Reducing stroke occurrence requires the effective management of cardiovascular and other stroke risk factors. Purpose: To describe pre- and post-stroke medication use, focusing on antithrombotic therapy and mortality risk, in individuals hospitalised for ischaemic stroke (IS) in the United Kingdom. Method: Using primary care electronic health records from the United Kingdom, we identified patients hospitalised for IS (July 2016–September 2019) and classed them into three groups: atrial fibrillation (AF) diagnosed pre-stroke, AF diagnosed post-stroke, and non-AF stroke (no AF diagnosed pre-/post-stroke). We determined use of cardiovascular medications in the 90 days pre- and post-stroke and calculated mortality rates. Results: There were 3201 hospitalised IS cases: 76.2% non-AF stroke, 15.7% AF pre-stroke, and 8.1% AF post-stroke. Oral anticoagulant (OAC) use increased between the pre- and post-stroke periods as follows: 54.3%–78.7% (AF pre-stroke group), 2.3%–84.8% (AF post-stroke group), and 3.4%–7.3% (non-AF stroke group). Corresponding increases in antiplatelet use were 30.8%–35.4% (AF pre-stroke group) 38.5%–47.5% (AF post-stroke group), and 37.5%–87.3% (non-AF stroke group). Among all IS cases, antihypertensive use increased from 66.8% pre-stroke to 78.8% post-stroke; statin use increased from 49.6%–85.2%. Mortality rates per 100 person-years (95% CI) were 17.30 (14.70–20.35) in the AF pre-stroke group and 9.65 (8.81–10.56) among all other stroke cases. Conclusion: Our findings identify areas for improvement in clinical practice, including optimising the level of OAC prescribing to patients with known AF, which could potentially help reduce the future burden of stroke.