Who Ordered The Antiplatelet Therapy?: Analysis Of ED Provider Use Of Antiplatelet Therapy In The Setting Of CVA AND TIA
BACKGROUND: Ischemic Cerebrovascular Accidents (CVAs) and Transient Ischemic Attacks (TIAs) are a growing cause of significant morbidity and mortality worldwide. Current guidelines recommend antiplatelet therapy within the first 48 hours for proven benefit in these patients.
OBJECTIVE: To assess how often emergency medicine (EM) providers are ordering antiplatelet therapy for TIA/CVA patients prior to disposition from the emergency department (ED).
METHOD: A retrospective chart review from January 1, 2016 through November 30, 2017 was performed on all patients who presented at Borgess Emergency Department and diagnosed with TIA/CVA. The primary outcome was to determine the rate at which emergency medicine providers are prescribing antiplatelet therapy on qualified patients in accordance with early management of acute ischemic stroke. Exclusion criteria was deemed for patients who received thrombolytics as therapeutic intervention, presented with symptom onset greater than 48 hours, those with an allergy to aspirin, all those already previously prescribed antiplatelet therapies, or who received aspirin in the pre-hospital setting.
RESULTS: Data was collected from 257 patient encounters. 81 patients were diagnosed with acute TIA/CVA who did not meet the previously defined study exclusion criteria. 40 (49.4%) of these patients were prescribed antiplatelet medication by the emergency medicine provider. However, 100% of patients did receive ASA within 48 hours.
CONCLUSION: There is opportunity for improvement for emergency department providers to initiate antiplatelet therapy for TIA/CVA patients. However, further inquiry is required to determine if this would lead to improved patient outcomes.