To provide evidence on the nature and extent of guideline non-adherence antiplatelet therapy in patients with acute ischemic stroke/transient ischemic attack who were presented to community hospital.

Antithrombotic therapy agents is recommended for nearly all acute ischemic stroke/Transient ischemic attack (TIA) patients without contraindications.

Dual antiplatelet is recommended only in very specific patients including minor stroke or high-risk transit ischemic attack or severe intracranial artery disease (ICAD). The American Stroke Association provides guidelines on the standard of care for antiplatelet use after acute ischemic stroke or TIA.

This is a prospective observational study collecting data using the stroke repository data set at HCA Florida Westside Regional hospital. Primary outcome is indicating whether the appropriate antiplatelet was prescribed for patient who admitted as stroke or TIAs. The secondary outcome is finding that risk factors associated with guideline deviation. Multivariate logistic regression analysis, using backward stepwise model, the association of potential risk factors for unintentional deviation from the guideline was analyzed.

Patients (mean age 68.7 male 48% were presented as acute stroke call alert during the study period. Of those patients 44% had stroke (67% mini stroke as NIHSS < 3 and 58% had ICAD).  Guidelines nonadherence happened 5.9 % in mini stroke group and 8.7 % in ICAD group.  Guideline deviations also occurred in 11.7 % of patients with TIA, of those 12% had post-treatment deviations including dispense and prescription deviation which was intervened by pharmacist. The most common protocol deviations were in minor stroke and TIA group.

Adherence to guidelines that recommend the prescription of antiplatelet is higher in inpatient at community hospital in comparison with other studies. Age is most associated with guidelines deviation in TIAs patients. Proper education at time of discharge can improve guideline adherence.