Use of antithrombotic medications among elderly ischemic stroke patients

Judith H. Lichtman, Lisa Naert, Norrina B. Allen, Emi Watanabe, Sara B. Jones, Lisa C. Barry, Dawn Bravata, Larry B. Goldstein

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background-The use of antithrombotic medications after ischemic stroke is recommended for deep vein thrombosis prophyla×is and secondary stroke prevention. We assessed the rate of receipt of thesetherapies among eligible ischemic stroke patients age ≥65 years and determined the effects of age and other patient characteristics on treatment. Methods and Results-The analysis included Medicare fee-for-service beneficiaries discharged with ischemic stroke (ICD 433.×1, 434.×1, 436) randomly selected for inclusion in the Medicare Health Care Quality Improvement Program's National Stroke Project 1998 to 1999, 2000 to 2001. Patients discharged from nonacute facilities, transferred, or terminally ill were e×cluded. Receipt of in-hospital pharmacological deep vein thrombosis prophyla×is, antiplatelet medication, anticoagulants for atrial fibrillation, and antithrombotic medications at discharge were assessed in eligible patients, stratified by age (65 to 74, 75 to 84, and 85+ years). Descriptive models identified characteristics associated with treatment. Among 31 554 patients, 14.9% of those eligible received pharmacological deep vein thrombosis prophyla×is, 83.9% antiplatelet drugs, 82.8%anticoagulants for atrial fibrillation, and 74.2% were discharged on an antithrombotic medication. Rates of treatment decreased with age and were lowest for patients ages 85 years or older. Admission from a skilled nursing facility and functional dependence were associated with lower treatment rates. Conclusions-There was substantial underutilization of antithrombotic therapies among elderly ischemic stroke patients, particularly among the very elderly, those admitted from skilled nursing facilities, and patients with functional dependence. The reasons for low use of antithrombotic therapies, including the apparent underutilization of deep vein thrombosis prophyla×is in otherwise eligible patients, require further investigation.

Original languageEnglish
Pages (from-to)30-38
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Volume4
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Stroke
Venous Thrombosis
Skilled Nursing Facilities
Medicare
Anticoagulants
Atrial Fibrillation
Therapeutics
Pharmacology
Fee-for-Service Plans
Terminally Ill
Platelet Aggregation Inhibitors
Quality Improvement
Secondary Prevention
Delivery of Health Care

Keywords

  • Deep vein thrombosis
  • Elderly
  • Medical care
  • Secondary prevention
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lichtman, J. H., Naert, L., Allen, N. B., Watanabe, E., Jones, S. B., Barry, L. C., ... Goldstein, L. B. (2011). Use of antithrombotic medications among elderly ischemic stroke patients. Circulation: Cardiovascular Quality and Outcomes, 4(1), 30-38. https://doi.org/10.1161/CIRCOUTCOMES.109.850883

Use of antithrombotic medications among elderly ischemic stroke patients. / Lichtman, Judith H.; Naert, Lisa; Allen, Norrina B.; Watanabe, Emi; Jones, Sara B.; Barry, Lisa C.; Bravata, Dawn; Goldstein, Larry B.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 4, No. 1, 01.2011, p. 30-38.

Research output: Contribution to journalArticle

Lichtman, JH, Naert, L, Allen, NB, Watanabe, E, Jones, SB, Barry, LC, Bravata, D & Goldstein, LB 2011, 'Use of antithrombotic medications among elderly ischemic stroke patients', Circulation: Cardiovascular Quality and Outcomes, vol. 4, no. 1, pp. 30-38. https://doi.org/10.1161/CIRCOUTCOMES.109.850883
Lichtman, Judith H. ; Naert, Lisa ; Allen, Norrina B. ; Watanabe, Emi ; Jones, Sara B. ; Barry, Lisa C. ; Bravata, Dawn ; Goldstein, Larry B. / Use of antithrombotic medications among elderly ischemic stroke patients. In: Circulation: Cardiovascular Quality and Outcomes. 2011 ; Vol. 4, No. 1. pp. 30-38.
@article{5728171411784971930f91bcfe2083ac,
title = "Use of antithrombotic medications among elderly ischemic stroke patients",
abstract = "Background-The use of antithrombotic medications after ischemic stroke is recommended for deep vein thrombosis prophyla×is and secondary stroke prevention. We assessed the rate of receipt of thesetherapies among eligible ischemic stroke patients age ≥65 years and determined the effects of age and other patient characteristics on treatment. Methods and Results-The analysis included Medicare fee-for-service beneficiaries discharged with ischemic stroke (ICD 433.×1, 434.×1, 436) randomly selected for inclusion in the Medicare Health Care Quality Improvement Program's National Stroke Project 1998 to 1999, 2000 to 2001. Patients discharged from nonacute facilities, transferred, or terminally ill were e×cluded. Receipt of in-hospital pharmacological deep vein thrombosis prophyla×is, antiplatelet medication, anticoagulants for atrial fibrillation, and antithrombotic medications at discharge were assessed in eligible patients, stratified by age (65 to 74, 75 to 84, and 85+ years). Descriptive models identified characteristics associated with treatment. Among 31 554 patients, 14.9{\%} of those eligible received pharmacological deep vein thrombosis prophyla×is, 83.9{\%} antiplatelet drugs, 82.8{\%}anticoagulants for atrial fibrillation, and 74.2{\%} were discharged on an antithrombotic medication. Rates of treatment decreased with age and were lowest for patients ages 85 years or older. Admission from a skilled nursing facility and functional dependence were associated with lower treatment rates. Conclusions-There was substantial underutilization of antithrombotic therapies among elderly ischemic stroke patients, particularly among the very elderly, those admitted from skilled nursing facilities, and patients with functional dependence. The reasons for low use of antithrombotic therapies, including the apparent underutilization of deep vein thrombosis prophyla×is in otherwise eligible patients, require further investigation.",
keywords = "Deep vein thrombosis, Elderly, Medical care, Secondary prevention, Stroke",
author = "Lichtman, {Judith H.} and Lisa Naert and Allen, {Norrina B.} and Emi Watanabe and Jones, {Sara B.} and Barry, {Lisa C.} and Dawn Bravata and Goldstein, {Larry B.}",
year = "2011",
month = "1",
doi = "10.1161/CIRCOUTCOMES.109.850883",
language = "English",
volume = "4",
pages = "30--38",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Use of antithrombotic medications among elderly ischemic stroke patients

AU - Lichtman, Judith H.

AU - Naert, Lisa

AU - Allen, Norrina B.

AU - Watanabe, Emi

AU - Jones, Sara B.

AU - Barry, Lisa C.

AU - Bravata, Dawn

AU - Goldstein, Larry B.

PY - 2011/1

Y1 - 2011/1

N2 - Background-The use of antithrombotic medications after ischemic stroke is recommended for deep vein thrombosis prophyla×is and secondary stroke prevention. We assessed the rate of receipt of thesetherapies among eligible ischemic stroke patients age ≥65 years and determined the effects of age and other patient characteristics on treatment. Methods and Results-The analysis included Medicare fee-for-service beneficiaries discharged with ischemic stroke (ICD 433.×1, 434.×1, 436) randomly selected for inclusion in the Medicare Health Care Quality Improvement Program's National Stroke Project 1998 to 1999, 2000 to 2001. Patients discharged from nonacute facilities, transferred, or terminally ill were e×cluded. Receipt of in-hospital pharmacological deep vein thrombosis prophyla×is, antiplatelet medication, anticoagulants for atrial fibrillation, and antithrombotic medications at discharge were assessed in eligible patients, stratified by age (65 to 74, 75 to 84, and 85+ years). Descriptive models identified characteristics associated with treatment. Among 31 554 patients, 14.9% of those eligible received pharmacological deep vein thrombosis prophyla×is, 83.9% antiplatelet drugs, 82.8%anticoagulants for atrial fibrillation, and 74.2% were discharged on an antithrombotic medication. Rates of treatment decreased with age and were lowest for patients ages 85 years or older. Admission from a skilled nursing facility and functional dependence were associated with lower treatment rates. Conclusions-There was substantial underutilization of antithrombotic therapies among elderly ischemic stroke patients, particularly among the very elderly, those admitted from skilled nursing facilities, and patients with functional dependence. The reasons for low use of antithrombotic therapies, including the apparent underutilization of deep vein thrombosis prophyla×is in otherwise eligible patients, require further investigation.

AB - Background-The use of antithrombotic medications after ischemic stroke is recommended for deep vein thrombosis prophyla×is and secondary stroke prevention. We assessed the rate of receipt of thesetherapies among eligible ischemic stroke patients age ≥65 years and determined the effects of age and other patient characteristics on treatment. Methods and Results-The analysis included Medicare fee-for-service beneficiaries discharged with ischemic stroke (ICD 433.×1, 434.×1, 436) randomly selected for inclusion in the Medicare Health Care Quality Improvement Program's National Stroke Project 1998 to 1999, 2000 to 2001. Patients discharged from nonacute facilities, transferred, or terminally ill were e×cluded. Receipt of in-hospital pharmacological deep vein thrombosis prophyla×is, antiplatelet medication, anticoagulants for atrial fibrillation, and antithrombotic medications at discharge were assessed in eligible patients, stratified by age (65 to 74, 75 to 84, and 85+ years). Descriptive models identified characteristics associated with treatment. Among 31 554 patients, 14.9% of those eligible received pharmacological deep vein thrombosis prophyla×is, 83.9% antiplatelet drugs, 82.8%anticoagulants for atrial fibrillation, and 74.2% were discharged on an antithrombotic medication. Rates of treatment decreased with age and were lowest for patients ages 85 years or older. Admission from a skilled nursing facility and functional dependence were associated with lower treatment rates. Conclusions-There was substantial underutilization of antithrombotic therapies among elderly ischemic stroke patients, particularly among the very elderly, those admitted from skilled nursing facilities, and patients with functional dependence. The reasons for low use of antithrombotic therapies, including the apparent underutilization of deep vein thrombosis prophyla×is in otherwise eligible patients, require further investigation.

KW - Deep vein thrombosis

KW - Elderly

KW - Medical care

KW - Secondary prevention

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=79952784597&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952784597&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.109.850883

DO - 10.1161/CIRCOUTCOMES.109.850883

M3 - Article

C2 - 21098780

AN - SCOPUS:79952784597

VL - 4

SP - 30

EP - 38

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 1

ER -