Abstract TP51: Improving Prescriptions of Cardiovascular-Effective Anti-Diabetic Medications in Patients With Stroke and Type 2 Diabetes

Stroke, Volume 55, Issue Suppl_1, Page ATP51-ATP51, February 1, 2024. Background and Issue:Type 2 diabetes (DM2) and cardiovascular (CV) disease pose significant risks for ischemic stroke, with a heightened impact on marginalized and under-resourced communities. Despite known CV benefits of newer anti-diabetic medications like glucagonlike peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 (SGLT2) inhibitors, these medications are under prescribed. To improve utilization, we conducted a quality improvement (QI) project to enhance prescription rates for these medications. The QI initiative focused on improving diabetes education and ensuring appropriate hypoglycemic medications were provided at discharge, with an aim of reducing the incidence of recurrent strokes.Purpose:The goal of this QI initiative was to improve prescription rates of GLP-1 R or SGLT2 inhibitors in eligible patients with stroke.Method:An assessment of current diabetic referral practices and medical therapy management were conducted, and an algorithm aimed at streamlining referrals for diabetic consults for patients with stroke developed. A diabetic educator or advanced practice nurse was consulted for patients with stroke and elevated A1c. Patients were then evaluated for qualification and use of GLP-1 RA or SGLT2 inhibitors, and discharge recommendations provided. A stroke registry was used to conduct a retrospective analysis of cases with stroke and DM2 for discharged prescriptions of GLP-1 R or SGLT2 inhibitors. Pre-implementation data from October 2021 to March 2022 were compared to post-implementation data from October 2022 to March 2023.Results:A review of 273 cases was completed. Prior to the QI implementation, 14.2% (19 of 134) of cases admitted for stroke with a secondary diagnosis of DM2 and elevated A1c were discharged home on a GLP-1 RA or SGLT2 inhibitor compared with 28.8% (40 of 139) of cases post implementation.Conclusion:Implementation of a QI process aimed at increasing the number of written discharge prescriptions for DM2 medications with proven CV benefits demonstrated a substantial increase in the number of written prescriptions for these medications at discharge.

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Febbraio 2024

Abstract 117: Bleeding Risks for Acute Ischemic Stroke Patients on Serotonergic Antidepressants and Anticoagulation/Dual Anti-Platelet Therapy

Stroke, Volume 55, Issue Suppl_1, Page A117-A117, February 1, 2024. Background:Selective serotonin/serotonin-norepinephrine reuptake inhibitors (SSRI/SNRIs) are associated with improved stroke recovery. Some clinicians withhold SSRI/SNRIs over bleeding risk concerns. Our objectives were: 1) Quantify the association between early initiation of SSRI/SNRIs and adverse bleeding events among acute ischemic stroke (IS) patients, 2) Determine bleeding risks among patients receiving anticoagulation (AC) or dual antiplatelet therapy (DAPT), and 3) Evaluate bleeding risks between anti-depressant (AD) classes.Methods:Medication naïve first-time IS patients were identified from Electronic Medical Records of 70 healthcare organizations (2003-2023). Patients without ADs were considered “No AD”. Patients started on ADs within 3 months of the indexed stroke were classified as “SSRI/SNRI” or “Other AD” (i.e., Mirtazapine, bupropion, trazodone, or tricyclic ADs). The primary outcome was 1-year risk of major bleeding events (e.g., gastrointestinal/intracranial or shock). Secondary outcomes were hemorrhagic stroke (HS), fall and death. Baseline differences were adjusted for using 1:1 matched propensity scores.Results:A total of n=666,150 patients were included [No AD (n=607,278), SSRI/SNRI (n=35,631), Other AD (n=23,241)]. Early use of SSRI/SNRIs (vs. No ADs) was not associated with an increased risk of a major bleed for all patients (n=35,557 matched pairs) or among patients on AC (n=7,672 matched pairs). However, concurrent use of SSRI/SNRIs and DAPT was associated with a 29% increased risk of HS (RR:1.29, 95% CI: 1.11-1.50, n=8,381 matched pairs). Among patients on ADs, bleed risks were higher for use of “Other ADs” vs. “SSRI/SNRIs” (n=21,810 matched pairs).Discussion:SSRI/SNRIs treat post-stroke depression, promote functional recovery and are generally safe to start during the early stages of recovery for patients with IS. However, an increased risk of HS should be considered when starting ADs among patients on DAPT.

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Febbraio 2024