Rapid change in prescribing behavior in hospitals participating in get with the guidelines-stroke after release of the management of atherothrombosis with clopidogrel in high-risk patients (MATCH) clinical trial results.

Abstract

BACKGROUND AND PURPOSE:

Physician prescribing patterns change slowly despite published randomized trials and consensus guidelines. We measure the effect of Management of Atherothrombosis With Clopidogrel in High-Risk Patients (MATCH) trial on discharge prescribing patterns for patients with stroke and those with transient ischemic attack in the Get With The Guidelines (GWTG)-Stroke Program.

METHODS:

We analyzed discharge prescribing patterns of antithrombotic medications for patients admitted with ischemic stroke or transient ischemic attack at hospitals participating in GWTG-Stroke between October 2002 to January 2006. Clinical information by quarter was analyzed in relation to publication of the MATCH study. Frequency of discharge prescription of aspirin+clopidogrel post-MATCH publication was compared with the pre-MATCH period after adjusting for patient and hospital characteristics and clustering by hospital.

RESULTS:

A total of 107 872 patients at 632 sites were eligible to receive antithrombotic therapy at discharge. Use of aspirin+clopidogrel therapy declined from 22.4% to 15.4% of patients after the publication of MATCH (adjusted OR 0.62, 95% CI 0.56 to 0.70, P<0.0001). Analysis by quarter revealed a rapid and sustained decrease in use of aspirin+clopidogrel therapy for the remainder of the study period.

CONCLUSIONS:

A rapid and sustained reduction in the frequency of aspirin+clopidogrel use in ischemic stroke and transient ischemic attack was observed after publication of the MATCH trial in the absence of MATCH-specific GWTG-Stroke initiatives and preceding an American Heart Association guideline update.

• Authors: Bijoy K Menon, Michael R Frankel, Li Liang, Kenneth A Labresh, Gray Ellrodt, Adrian F Hernandez, Gregg C Fonarow, Lee H Schwamm, Eric E Smith, Get With The Guidelines-Stroke Steering Committee and Investigators
• Journal: Stroke (Stroke) Vol. 41 Issue 9 Pg. 2094-7 (Sep 2010) ISSN: 1524-4628 [Electronic] United States
• PMID: 20634476 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Aspirin (therapeutic use)
• Brain Ischemia (drug therapy)
• Clinical Trials as Topic
• Clopidogrel
• Drug Therapy, Combination
• Humans
• Platelet Aggregation Inhibitors (therapeutic use)
• Practice Guidelines as Topic
• Practice Patterns, Physicians' (trends)
• Prescriptions
• Stroke (drug therapy)
• Ticlopidine (analogs & derivatives, therapeutic use)
• United States