Systematic review and meta-analysis of audits measuring antithrombotic therapy within forty-eight hours for ischemic stroke

AbstractBackground Meta-analysis of clinical trials supports the use of early antithrombotic medication in ischemic stroke and transient ischemic attack. It is not known whether this therapy is delivered within the 85 % threshold that is acceptable in North America's Get With The Guidelines stroke program. Aim to investigate the pooled proportion of patients receiving antiplatelet therapy within 48 h of ischemic stroke. Methods PubMed to November 2022 was searched for studies reporting "stroke", "audit", "antithrombotic", "national" and "registry". Multilevel random effects meta-analysis was used to cluster studies by country. Results There were 45 studies describing 1,178,595 patients. The pooled proportion of patients receiving antithrombotic therapy within 48 h was 81.1 %, (95 % CI 74.5, 87.8, p 2=99.99 %). The high heterogeneity was due to within-country (I2Level 3 = 55.4 %) and between-country heterogeneity (I2Level 2 = 44.6 %). There was no statistical significance (p = 0.35) between low- to middle- income countries (LMIC) – 81.8 %, (95 % CI 76.1, 87.4, p 2=100 %) and high-income countries (HIC) – 86.8 %, (95 % CI 81.2, 92.3, p 2=99.7 %) nor any difference between contemporary studies (2008 and later) – 86.5 %, (95 % CI 82.3, 90.8, p 2=100 %) – and studies published before 2008 – 69.9 %, (95 % CI 57.4, 82.4, p 2=99.7 %). Sensitivity analysis showed no difference when excluding single centre studies, observations with n p Conclusion Our key finding is that the majority of countries do not yet provide early antiplatelet therapy at a level acceptable by Get With The Guidelines hospitals.