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      Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East

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          Abstract

          Background and purpose

          Guidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1–3 days from onset should be offered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective database.

          Methods

          The Qatar Stroke Database began the enrollment of patients with TIAs and acute stroke in 2014 and currently has ~16,000 patients. For this study, we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with an ABCD2 score of 4, and a minor stroke was defined as an NIHSS of 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed.

          Results

          After excluding patients with ICH, mimics, and rare secondary causes, 8,082 patients were available for final analysis (TIAs: 1,357 and stroke: 6,725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor strokes, 1,207 of 3,572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately offered to 238 of 691 (34.4%) low-risk TIAs and 809 of 3,153 (25.7%) non-minor stroke patients.

          Conclusion

          This large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from the hospital. This requires urgent attention and further investigation.

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          Most cited references49

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          Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

          Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results- These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions- These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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            2020 International Society of Hypertension Global Hypertension Practice Guidelines

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              2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association

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                Author and article information

                Contributors
                Role: Role: Role:
                URI : http://loop.frontiersin.org/people/1045423/overviewRole: Role: Role: Role:
                Role: Role: Role:
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                URI : http://loop.frontiersin.org/people/9131/overviewRole: Role: Role:
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                09 November 2023
                2023
                : 14
                : 1269292
                Affiliations
                [1] 1Department of Medical Education, Weill Cornell College of Medicine , Doha, Qatar
                [2] 2The Neuroscience Institute, Hamad Medical Corporation , Doha, Qatar
                [3] 3Neurology Division, Department of Medicine, University of Alberta , Edmonton, AB, Canada
                Author notes

                Edited by: Shinichiro Uchiyama, Sanno Medical Center, Japan

                Reviewed by: Anastasios Apostolos, National and Kapodistrian University of Athens, Greece; Lisa Woodhouse, University of Nottingham, United Kingdom

                *Correspondence: Ashfaq Shuaib ashfaq.shuaib@ 123456ualberta.ca
                Article
                10.3389/fneur.2023.1269292
                10666165
                df55e5f6-299a-4310-94e9-f37ec49e1a93
                Copyright © 2023 Naveed, Akhtar, Al-Jerdi, Uy, Joseph, Morgan, Babu, Shanthi and Shuaib.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 29 July 2023
                : 16 October 2023
                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 50, Pages: 13, Words: 8423
                Funding
                The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
                Categories
                Neurology
                Original Research
                Custom metadata
                Stroke

                Neurology
                tia,stroke,antiplatelet,modified rankin scale,guidelines,dapt
                Neurology
                tia, stroke, antiplatelet, modified rankin scale, guidelines, dapt

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