After high-risk transient ischemic attack (TIA) and minor acute ischemic stroke (AIS), clinical guidelines advise the use of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel to help prevent recurrent acute ischemic events.

Yet, some patients, especially females, are still maintained only on single antiplatelet therapy, according to University of Maryland–led authors. They sought to identify the variations in single versus dual antiplatelet prescribing practices at the time of discharge within a Stroke Clinical Network. Participating in the study were nine stroke centers located in rural, suburban, and urban geographical regions.

“All stroke survivors, regardless of sex, should receive optimal proven medications for stroke prevention including DAPT when medically appropriate,” said Jonathan Solomonow, MD, lead author of the study and chief resident in neurology at the University of Maryland Medical Center in Baltimore.

The study was presented recently at presented at the American Stroke Association’s International Stroke Conference 2023. The meeting is being held in person in Dallas and virtually from February 8 to 10, 2023.

The study team queried the Get With The Guidelines stroke registry for all adult patients with a TIA or a minor AIS—defined as admission with NIHSS 5 or under—who were admitted to a single hospital network between January 2018 and December 2021. Information on age, race, gender, and BMI was collected for the study, which excluded patients on concurrent anticoagulation.

The researchers evaluated antiplatelet discharge practices at the tertiary stroke center versus the entire network, among men versus women, African Americans (AA) versus whites, aged 18 to 70 years versus 70 years or older, and across BMI.

Within the 2,953 patients included with a TIA or minor AIS, the mean age was 67, with 42% aged 70 years or older, 47.8% women, 37% were AA, and 60% were white.

“DAPT was prescribed at the time of discharge to 40% of patients overall,” the authors explained. “Gender was a significant factor with men (43%) more likely to get prescribed DAPT than females (37%; P = .002). While BMI did not have a lone effect on number of antiplatelets (AP) prescribed, when it was included as a covariate, there was a significant effect on the number of AP prescribed; with the higher the BMI, the less likely patients were to receive DAPT. Differences according to age, race, and effect of whether the patient was discharged from a tertiary center were not significant.”

The researchers concluded that underutilization of DAPT following TIA and minor stroke occurred across the health system, especially in women, “Targeted intervention to increase DAPT use could lead to reduced rate of short-term stroke recurrence.”

“There are an increasing number of options available to prevent and reduce the risk of a recurrent stroke, including high blood pressure medications, statins to control cholesterol and dual blood thinners. Patients and their family members should inquire about the use of DAPT after a stroke or TIA to consider if DAPT may be beneficial,” Dr. Solomonow stated in a press release.

He added that the gender gap noted in the study could not be explained by differences in insurance coverage or anticipated side effects of the medications, pointing out, “The gender gap was not entirely surprising because there is extensive literature indicating that women with cardiovascular disease tend to be undertreated. For example, some studies show that women with heart disease or stroke are not prescribed statins as frequently as men. In addition, women with atrial fibrillation receive ablation less often than men,” Dr. Solomonow said. “Further research is needed to examine whether women are less likely to receive other proven therapies, such as statins for stroke prevention and anticoagulation for atrial fibrillation.”

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