AUTHOR=Liu Tingting , Li Yanan , Niu Xiaoyuan , Wang Yongle , Zhang Kaili , Fan Haimei , Ren Jing , Li Juan , Fang Yalan , Li Xinyi , Wu Xuemei 

TITLE=Factors affecting physician decision-making regarding antiplatelet therapy in minor ischemic stroke

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.937417

DOI=10.3389/fneur.2022.937417

ISSN=1664-2295

ABSTRACT=<sec><title>Purpose</title><p>To identify the most important factors affecting physician decision-making regarding antiplatelet therapy.</p></sec><sec><title>Methods</title><p>We retrospectively gathered data from minor ischemic stroke patients with NIHSS scores ≤ 5 within 72 h of onset from 2010 to 2018. The population was divided into four groups by initial antiplatelet therapy: aspirin monotherapy (AM), dual antiplatelet therapy with aspirin and a loading dose of clopidogrel (clopidogrel loading dose of 300 mg on the first day; DAPT-ALC), dual antiplatelet therapy with aspirin and no loading dose of clopidogrel (clopidogrel 75 mg daily, no loading dose; DAPT-AUC), and clopidogrel monotherapy (CM).</p></sec><sec><title>Results</title><p>In total, 1,377 patients were included in the analysis (excluding patients who accepted thrombolytic drugs, participated in other clinical trials, or had not used antiplatelet drugs). The mean ± S.D. age was 62.0 ± 12.7 years; 973 (70.7%) patients were male. The four groups were AM (<italic>n</italic> = 541, 39.3%), DAPT-ALC (<italic>n</italic> = 474, 34.4%), DAPT- AUC (<italic>n</italic> = 301, 21.9%), and CM (<italic>n</italic> = 61, 4.4%). Patients receiving antiplatelet monotherapy were older than those receiving dual antiplatelet therapy (63.7–65.7 vs. 59.6–61.4 years), and the median initial systolic blood pressure level was higher in the DAPT-ALC group than in the other groups (all <italic>P</italic> &lt; 0.05). Patients under 75 years old with an admission SBP lower than 180 mmHg, a history of AM, coronary heart disease, no history of intracerebral hemorrhage, stroke onset occurring after guideline recommendations were updated (the year of 2015), onset-to-arrival time within 24 h, and initial NIHSS score ≤ 3 were more likely to take DAPT-ALC than AM. Compared with DAPT-ALC, DAPT-AUC was associated with an initial SBP level lower than 180 mmHg, a history of smoking, hypertension, no history of ICH, previous treatment with antihypertensives, and onset year after the recommendations were updated.</p></sec><sec><title>Conclusions</title><p>Many factors affect doctors' decisions regarding antiplatelet therapy, especially guidelines, age, admission SBP level, and hypertensive disease.</p></sec>