Thursday, February 02, 2023

MISOGYNISTIC MEDICINE

Dual blood thinners under prescribed after minor or warning stroke, especially in women


American Stroke Association International Stroke Conference 2023, Abstract 43

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • In a recent study, less than half of the people were prescribed dual blood-thinning therapy, despite evidence that starting two anti-platelet blood thinning medications, such as aspirin or clopidogrel, may reduce the short-term risk of recurrent stroke after a minor stroke or a transient ischemic attack (TIA) - also known as a warning stroke.
  • In the analysis of medications prescribed to nearly 3,000 stroke survivors at discharge from stroke centers in Maryland, only 40% of patients were prescribed dual anti-platelet therapy, and women were significantly less likely to be prescribed two anti-platelet medications compared to men. This gender gap in treatment echoes under-treatment of women in other aspects of cardiovascular disease care.
  • Increasing the use of dual anti-platelet therapy, particularly in women, may lead to a lower rate of stroke recurrence after a minor stroke or TIA.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023

DALLAS, Feb. 2, 2023 — Despite evidence that starting two blood-thinning medications shortly after a minor stroke or a warning stroke (transient ischemic attack - TIA) may prevent a second – possibly more serious – clot-caused stroke within a few months, the treatment regimen is underused especially among women, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Blood thinners, such as aspirin and clopidogrel, prevent platelets from sticking together and forming blood clots. Prescribing two anti-platelet medications at the same time is known as dual antiplatelet therapy (DAPT). In recent trials, DAPT has been shown to reduce the short-term risk of another stroke in people with a recent minor stroke (mild, non-disabling symptoms) or with a TIA. As with most strokes, a TIA is caused by a clot temporarily blocking blood flow to the brain, however, TIA symptoms usually only last a few minutes and result in no permanent brain injury or physical disability.

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

To gauge how often DAPT was being prescribed when people with a minor stroke or TIA were discharged, the researchers reviewed the electronic health records of 2,953 adults admitted to one of the hospitals of the University of Maryland Stroke Clinical Network. The Maryland network includes nine stroke centers located in urban, suburban and rural hospitals serving a diverse population. All were treated for minor stroke or TIA between 2018 and 2021. None were taking blood thinning medication such as warfarin or apixaban before the stroke or TIA. The participants were average age 67 years; 42% were age 70 or older; 48% women, 37% Black adults and 60% white adults.

The analysis found:

  • DAPT was underutilized across all hospitals reviewed, prescribed to just 40% of the overall patients.
  • Men were more likely than women (43% vs. 37%, respectively) to be prescribed DAPT.
  • The percentage of patients receiving DAPT did not differ significantly by race, age or whether the person was treated at a stroke center that delivers specialized stroke care.

“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,” Solomonow said.

The gender gap noted in the study could not be explained by differences in insurance coverage or in anticipated side effects of the medications, Solomonow added.

“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,” 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 anti-coagulation for atrial fibrillation.”

The study analyzed data from a single health system in Maryland, so the findings need to be confirmed in other settings including hospitals that are not certified stroke centers.

“Identifying systemic inequities is essential to improving patient care across all demographics. It would be useful for other centers to explore whether sex differences are present in other parts of the U.S. or health care systems in other countries,” Solomonow said.

Co-authors are Jamie R. Marks, Ph.D.; Karen L. Yarbrough, C.R.N.P.; Prachi Mehndiratta, M.B.B.S.; and Seemant Chaturvedi, M.D. Authors’ disclosures are listed in the abstract.

The study was funded by the department of neurology at the University of Maryland.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:


Recurrent stroke risk decreasing, with twice the decline among women vs. men in South Texas


American Stroke Association International Stroke Conference 2023, Abstract 82

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • The risk of recurrent stroke has declined in the past 20 years among all stroke survivors, with twice the decline among women vs. men, according to a study conducted in South Texas.

  • Researchers suggest more study is needed to understand the reasons behind the welcome decline in trends in stroke recurrence for both sexes, as well as the reasons for the changes in sex differences over time.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023

DALLAS, Feb. 2, 2023 — The risk of recurrent stroke has declined in the past 20 years among all stroke survivors, with twice the decline among women compared to men, according to preliminary research conducted in South Texas that will be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Stroke Association, a division of the American Heart Association, after a first stroke, about 1 in 4 people will go on to have another. The majority of recurrent strokes are preventable through the same lifestyle changes, and medication if necessary, that may help prevent a first stroke or other cardiovascular diseases.

In the Brain Attack Surveillance in Corpus Christi (BASIC) Project in South Texas, researchers analyzed the frequency of recurrent stroke between January 1, 2000, and December 31, 2019 among nearly 6,000 first-time ischemic stroke survivors. Half of the stroke survivors were women, and their average age was 69 years. Participants self-identified as Mexican American (52.5%), non-Hispanic white (40.4%) and other races or ethnicities (7.1%).

The analysis found:

  • Overall, nearly 14 out of 100 stroke survivors had a second stroke within about 8 years.
  • In 2000, approximately 11 out of 100 women had a recurrent stroke within one year, compared to 8 out of 100 men.
  • Over the two decades, the risk of recurrent stroke declined among all stroke survivors; however, women experienced twice the decline compared to men. Fewer than 4 out of 100 women experienced a recurrent stroke one year after a first stroke, compared to nearly 5 out of 100 men.
  • Similar results occurred five years after a first stroke, with 8 out of 100 women compared to 10 out of 100 men experiencing a recurrent stroke.

“Secondary stroke prevention has been successful; however, it has not been as effective among male stroke survivors in recent years,” said study lead author Chen Chen, M.S., a Ph.D. candidate in epidemiology at the University of Michigan in Ann Arbor. “We were somewhat surprised that our results showed that in recent years men had similar or even higher chances of having a second stroke compared with women.”

The study had a few limitations. One limitation is that all study participants lived in one South Texas community (Nueces County, Texas), so the results may not apply to people living in other areas. Another limitation is that the study did not include details about subtypes of recurrent stroke, which may point to additional risk factors and the need for more targeted secondary prevention strategies.

“Further research is needed to understand the reasons behind the welcome declining trends in stroke recurrence for both sexes, particularly the reasons for differences over time by sex,” Chen said. “This information will help policymakers understand where to focus efforts that may further improve secondary stroke prevention and reduce or prevent health inequities.”

According to the American Stroke Association, a division of the American Heart Association, worldwide, stroke is the second-leading cause of death after heart disease. Stroke is a medical emergency that occurs when the blood vessels to the brain become blocked, which is an ischemic stroke, the most common type, or they may burst, which is a hemorrhagic stroke. Immediate treatment to restore blood flow and oxygen to the brain may help prevent permanent disability. The abbreviation F.A.S.T. — for face drooping, arm weakness, speech difficulty, time to call 911 — is a useful tool to recognize the warning signs of stroke and when to call for help.

Co-authors are Kevin He, Ph.D.; Mathew J. Reeves, Ph.D.; Lewis B. Morgenstern, M.D.; Karen B. Farris, Ph.D.; and Lynda D. Lisabeth, Ph.D. Authors’ disclosures are listed in the abstract.

The study was funded by the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.


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