Key result
Chronic antiplatelet therapy linked to ~42% lower inpatient mortality in posterior circulation acute ischemic stroke.
Why the study?
Posterior circulation acute ischemic stroke (PCS) is a leading cause of neurologic disability, but the hospital course and outcomes of patients receiving chronic antiplatelet therapy (cAPT), including those undergoing endovascular thrombectomy (EVT), remained unclear.
Does chronic antiplatelet therapy improve inpatient clinical outcomes in adult patients hospitalized with posterior circulation acute ischemic stroke?
Cross-Sectional (n=148,740)
Yes
Does chronic antiplatelet therapy improve inpatient clinical outcomes in adult patients hospitalized with posterior circulation acute ischemic stroke?
Odds Ratio: 0.581 (95% CI 0.496–0.68)
p-value: p=<0.001
Chronic antiplatelet therapy prior to posterior circulation acute ischemic stroke hospitalization is associated with lower inpatient mortality, higher routine discharge, and fewer neurological complications, including among those undergoing endovascular thrombectomy.
Chronic antiplatelet use was associated with lower mortality; hypothesis-generating and should not yet change practice pending randomized confirmation.
Posterior circulation acute ischemic stroke (PCS) is a leading cause of neurologic disability, yet the hospital course of patients receiving chronic antiplatelet therapy (cAPT) remains unclear. This study evaluates the effect of cAPT on PCS outcomes, including patients undergoing endovascular thrombectomy (EVT). This retrospective cross-sectional study used the National Inpatient Sample (2015–2022), including adult (≥18 years) hospitalizations in the United States for PCS with reported NIH Stroke Scale. Outcomes included inpatient mortality, routine discharge, complications, and receipt of reperfusion therapy. Propensity score-based inverse probability of treatment weighting (IPTW) adjusted for confounding factors, including stroke severity. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Among 148,740 PCS hospitalizations, 46,125 (31.0%) were receiving cAPT. These patients demonstrated reduced likelihood of undergoing intravascular thrombolysis (aOR: 0.902, 95% CI [0.835–0.975], p = 0.009) and EVT (0.868 [0.764–0.987], p = 0.031) compared to patients not on cAPT. Following IPTW, cAPT was associated with reduced inpatient mortality (0.581 [0.496–0.680], p < 0.001) and increased routine discharge (1.14 [1.08–1.21], p < 0.001). These patients also demonstrated reduced hemorrhagic transformation (0.767 [0.695–0.846], p < 0.001) and cerebral edema/herniation (0.761 [0.698–0.831], p < 0.001). Among hospitalizations undergoing EVT, cAPT was associated with reduced inpatient mortality (0.556 [0.408–0.757], p < 0.001), increased routine discharge (1.60 [1.18–2.16], p = 0.003), and reduced hemorrhagic transformation (0.778 [0.705–0.858], p < 0.001). cAPT was associated with favorable inpatient outcomes in PCS, including lower mortality without an increased risk of serious neurological complications. Positive associations persisted among patients undergoing EVT. Prospective research is needed to confirm these results and guide therapeutic strategies.
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Malhotra et al. (2026) conducted a cross-sectional in Posterior circulation acute ischemic stroke (PCS) (n=148,740). Chronic antiplatelet therapy (cAPT) vs. No chronic antiplatelet therapy was evaluated on Inpatient mortality (aOR 0.581, 95% CI 0.496-0.680, p=<0.001). Chronic antiplatelet therapy was associated with reduced inpatient mortality in posterior circulation acute ischemic stroke (aOR 0.581, 95% CI 0.496-0.680, p<0.001).
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