90-Days Outcomes In Patients With Minor Strokes Or Transient Ischemic Attacks Discharged On Single Vs Dual Anti Platelet-Therapy In the Middle East
Hiba Naveed1, Naveed Akhtar2, Ashfaq Shuaib3, Salman Al Jerdi1
1Weill Cornell Medicine - Qatar, 2Hamad Medical Corporation, 3University of Alberta
Objective:
To compare the 90-day outcome in patients with minor stroke (MIS) or transient ischemic attack (TIA) who were discharged on single versus dual anti-platelet therapy after index event in the multiethnic Middle Eastern community.
Background:
Recent studies have shown that dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is effective for secondary prevention after minor ischemic stroke (MIS) or transient ischemic attack (TIA). However, there is paucity of data from middle east regarding role of such intervention and outcome of these patients
Design/Methods:
- We inquired all Ischemic stroke and TIA patients from our prospectively collected stroke database admitted since January 2014. We separated them into two groups- discharged on single(SAP) vs DAPT. High risk group for recurrence was defined as patients with ABCD2 score of ≥ 4 or more and NIHSS ≤ 3 at index event. We assessed the outcome as measured with modified Rankin Score (mRS), recurrent ischemic stroke, and other vascular events.
Results:
The data provided yielded 1357 (16.8%) patients with TIAs and 6725 (83.2%) with MIS. Of these only 35% (1481/4219) of high risk patient were discharged on DAPT (38.5% of TIA patients and 30.0% MIS patients). DAPT was initiated within 24 hours of arrival at hospital in 86.3% of patients (p<0.001) with a mean duration of 12.5 ±15.6 hours (p<0.001). Poor outcome (mRS 3-6) (27.9% vs 15.1%, p<0.001), and increased mortality (2.2% vs 1.1%, p<0.001) was more significant in patients discharged on SAP versus DAPT.
Conclusions:
The rates of DAPT in patients with TIA and MIS is low. Patients with high risk TIA and MIS discharged on DAPT has better outcome at 90-days in ethnically diverse group of patients in the Middle East.