Key result
Recurrent LVO stroke is linked to ~92% higher baseline antiplatelet use versus first-time stroke.
Why the study?
Large vessel occlusion carries high morbidity and mortality, requiring effective prevention strategies, but intake of preventive medication at hospitalization in recurrent stroke presenting with acute LVO needed analysis.
Does the frequency of secondary preventive medication at admission differ between patients with recurrent versus first-time stroke presenting with large vessel occlusion?
Observational (n=866)
No
Does the frequency of secondary preventive medication at admission differ between patients with recurrent versus first-time stroke presenting with large vessel occlusion?
A significant proportion of patients presenting with recurrent stroke and large vessel occlusion are not receiving or adhering to adequate secondary preventive medication.
Higher pre-admission preventive medication rates in recurrent LVO stroke highlight adherence gaps; leaves open whether targeted interventions reduce recurrence.
BACKGROUND: Large vessel occlusion (LVO) is a severe condition that carries a high risk of morbidity and mortality, underscoring the importance of effective prevention strategies. This retrospective study aimed to analyze the intake of preventive medication at the time of hospitalization in a cohort of recurrent stroke patients presenting with acute LVO. METHODS: The study assessed the intake of either platelet aggregation inhibitors (PAI), oral anticoagulants (OAC) or statins at admission in patients with recurrent stroke and correlated it with the final classification of LVO. The frequency of those secondary preventive medication in recurrent stroke patients was defined as primary endpoint. The Modified Rankin Scale (mRS) at discharge was used as a functional outcome and defined as a secondary outcome measure. RESULTS: This study included 866 patients who were treated for LVO between 2016 and 2020, of whom 160 (18.5%) had a recurrent ischemic stroke. OAC (25.6% vs. 14.1%, p < 0.01), PAI (50.0% vs. 26.0%, p < 0.01), or statin therapy (50.6% vs. 20.8%, p < 0.01) at admission were significantly more frequent in recurrent stroke patients compared to patients with a first-time stroke. Concerning LVO etiology in recurrent stroke patients, OAC at admission was taken in 46.8% of cardioembolic LVO, whereas PAI and statin at admission in macroangiopathic LVO were administered to 40.0%; neither PAI nor OAC was taken in 26.0%, 28.3%, and 31.6% of cardioembolic, macroangiopathic, or cryptogenic strokes, respectively. Regardless of stroke recurrence or etiology, there was an increase in mRS at discharge. CONCLUSIONS: Despite high-quality healthcare, this study suggested a significant proportion of patients with recurrent stroke who were either non-adherent or insufficiently adherent to secondary preventive medication. Given the disability associated with LVO, improving patients' medication adherence and identifying unknown stroke causes are crucial for effective prevention strategies.
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Kohlhase et al. (2023) conducted an observational in Acute ischemic stroke caused by large vessel occlusion (LVO) (n=866). History of previous ischemic stroke (recurrent stroke) vs. First-time ischemic stroke was evaluated on Frequency of platelet aggregation inhibitors (PAI) at admission (p=<0.01). Patients with a recurrent ischemic stroke and large vessel occlusion were significantly more likely to be taking platelet aggregation inhibitors (50.0% vs 26.0%), statins (50.6% vs 20.8%), or oral anticoagulants (25.6% vs 14.1%) at admission compared to those with a first-time stroke.
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