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. 2022 Oct;31(10):106700.
doi: 10.1016/j.jstrokecerebrovasdis.2022.106700. Epub 2022 Aug 12.

Trends in post-discharge prophylactic anticoagulant use among stroke patients in the United States between 2006 and 2019

Ghadeer K Dawwas  1 , Adam Cuker  2 , Aaron Rothstein  3 , Sean Hennessy  4
Affiliations
Free article

Trends in post-discharge prophylactic anticoagulant use among stroke patients in the United States between 2006 and 2019

Ghadeer K Dawwas et al. J Stroke Cerebrovasc Dis. 2022 Oct.
Free article

Abstract

Background: Stroke is an independent risk factor for venous thromboembolism (VTE). Although the risk of VTE persists after hospital discharge, information on the utilization of anticoagulants among stroke patients after discharge remains limited.

Objective: To evaluate changes in post-discharge thromboprophylaxis among stroke patients between 2006 and 2019.

Methods: We conducted a retrospective repeated cross-sectional analysis using a commercial healthcare insurance database in the United States. We included patients aged ≥ 18 years with incident stroke diagnosis and assessed prophylactic use of anticoagulants in the 30 days following hospital discharge including low-molecular-weight heparin (enoxaparin ≤40 mg/day, dalteparin ≤5000 IU/day), unfractionated heparin ≤5000 IU/ twice daily or 3 times a day, apixaban 2.5 mg twice daily, and rivaroxaban 10 mg/day. Patients with atrial fibrillation, VTE, mechanical heart valves, cancer, antiphospholipid antibody syndrome, and users of therapeutic doses of anticoagulants were excluded. We used the Cochrane-Armitage test to assess changes in the use of anticoagulants across the study period.

Results: There was a small increase in the overall use of post-discharge prophylactic anticoagulants among stroke patients between 2006 and 2019 from 0.5% to 1.9%. The use of heparin decreased from 0.5% in 2006 to 0.3% in 2019 (P-value for trend = 0.001). In contrast, the use of apixaban or rivaroxaban increased from 0.1% in 2013 to 1.6% in 2019 (P-value for trend < 0.001). Apixaban was more commonly used than rivaroxaban.

Conclusions: In this population-based study of stroke patients, we found that post-discharge anticoagulant use remains low through 2019. Prophylactic use of heparin or rivaroxaban was relatively low but the use of apixaban increased over the study period. Further research is needed to determine if these agents are safe and effective for VTE prevention in stroke patients.

Keywords: Anticoagulants; Apixaban; Heparin; Stroke; Venous thromboembolism; Warfarin.

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Conflict of interest statement

Declaration of Competing Interest GKD receives funding from the American Society of Hematology and National Institutes of Health. AC has served as a consultant for Synergy and his institution has received research support on his behalf from Alexion, Bayer, Novartis, Novo Nordisk, Pfizer, Sanofi, and Spark. AR declares no conflicts of interest. SH has consulted for the Medullary Thyroid Cancer Consortium (Novo Nordisk, AstraZeneca, Eli Lilly and GlaxoSmithKline), Novo Nordisk, Arbor Pharmaceuticals, Biogen MA, Intercept Pharmaceuticals, and Provention Bio, Inc on matters unrelated to the topic of this paper.

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