Prior antiplatelet or anticoagulant therapy and mortality in stroke
- 1Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, UK
- 2Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- 3Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
- Correspondence to Dr Phyo Kyaw Myint, Norwich Medical School, Chancellors Drive, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK;
Contributors PKM conceptualised the article. CSK and JS analysed the data. CSK and PKM prepared the manuscript with critical input from all co-authors. AKM, JFP and PKM are steering group members of the Norfolk and Norwich Stroke Register. PKM is the guarantor.
- Accepted 18 January 2012
- Published Online First 10 February 2012
Objective To examine the influence of previous antiplatelet or anticoagulant therapy on subsequent stroke mortality at different time points up to 1 year post stroke.
Design Data were examined from a hospital register collected over 5 years (2004–2008).
Setting A single large university hospital.
Participants Every adult (18+ years) admitted with an acute stroke.
Main outcome measures Mortality risks at 7, 30, 60, 90 and 365 days were assessed using logistic regression following ischaemic and haemorrhagic stroke, adjusting for age, gender, premorbid Rankin and stroke type.
Results 3308 patients with first or recurrent stroke were included (53% women, mean age 77.7±11.5 years, 86% ischaemic stroke). One-year mortality was 35.2% (999) for ischaemic stroke and 48.3% (227) for haemorrhagic stroke. Compared with no previous therapy, the mortality following ischaemic stroke for those already receiving antiplatelets or anticoagulants was not associated with increased mortality at any time points up to 1 year after presentation in the fully adjusted model. However, patients with haemorrhagic stroke had a worse prognosis at all time points after standard risk factor adjustment. For patients who used aspirin or warfarin prior to haemorrhagic stroke compared with no use, ORs (95% CIs) were 1.31 (0.64 to 2.68) and 2.91 (1.23 to 6.89) for 7 days, 2.36 (1.18 to 4.71) and 2.37 (1.00 to 5.61) for 30 days, 2.18 (1.10 to 4.29) and 2.86 (1.20 to 6.84) for 60 days, 2.56 (1.27 to 5.13) and 2.82 (1.16 to 6.86) for 90 days and 1.67 (0.89 to 3.12) and 2.44 (1.06 to 5.62) for 365 days.
Conclusions Prior antiplatelet or anticoagulant use was associated with increased mortality following HS but not IS after adjustment for common factors associated with a poor prognosis. The reasons for this poor prognosis and potential therapeutic options need exploring in future studies.
- antiplatelet agents
- antiplatelet treatment
See Editorial, p 677
Funding Norfolk and Norwich Stroke Register is maintained by the Stroke Services, Norfolk and Norwich University Hospital with additional support from the Anglia Stroke and Heart Clinical Network, Eastern Strategic Health Authority.
Disclosures Dr Kwok, Dr Skinner and Dr Metcalfe report no disclosures. Professor Potter serves as Deputy Editor of Age and Ageing. Dr Myint serves as Associate Editor of BMC Health Services Research Journal and is an Editorial Board Member of Open Heart Failure Journal.
Competing interests None.
Patient consent This is a stroke register which collects information on every adult admitted with an acute stroke which has received institutional approval.
Ethics approval Norfolk and Norwich Hospital Trust Research and Development Committee.
Provenance and peer review Not commissioned; externally peer reviewed.