Analysis of Treatment Pattern of Antiplatelet in First-Ever Ischemic Stroke Without Previous Antiplatelet Use: A Real-World Distributed Network Analysis of 11 Observational Korean Databases Using a Common Data Model

Abstract

Background: Antiplatelet agents are widely prescribed to prevent cardiovascular events, with cardiovascular disease being the leading global cause of death and the second most common in Korea. As the demand for antiplatelets increases, understanding real-world prescribing patterns is essential. Methods: This study analyzed antiplatelet prescription trends for patients with first-ever ischemic stroke (IS) using 11 Korean observational databases transformed to a Common Data Model, spanning 1995-2023. Prescription shifts were assessed in relation to the 2013 CHANCE trial. Results: The analysis included 162,361 patients with first-ever IS who had no prior antiplatelet therapy. Aspirin was the most commonly prescribed initial medication (39.4%), followed by aspirin-clopidogrel combination (28.2%), clopidogrel alone (13.7%), and cilostazol (5.0%). Initial medication were typically maintained: however, some patients initially on aspirin or clopidogrel switched to dual antiplatelet therapy (DAPT; aspirin and clopidogrel), while those on initial DAPT primarily transitioned to clopidogrel, then to aspirin. Following the CHANCE trial, a marked shift in prescription patterns was observed. Before CHANCE, aspirin was predominant (45.7%), followed by aspirin-clopidogrel (19.2%), and clopidogrel (15.5%). Post-CHANCE, aspirin-clopidogrel became the leading therapy (40.6%), with aspirin (30.3%) and clopidogrel (11.3%) monotherapy. Conclusion: While aspirin remains the mainstay for secondary prevention of IS, the CHANCE trial significantly influenced increased use of DAPT. As evidence continues to grow for P2Y12 inhibitors in the IS context, analyzing antiplatelet prescription patterns is vital for evaluating the implementation of guidelines in clinical practice.