Discharge prescription patterns for antiplatelet and statin therapy following carotid endarterectomy: an analysis of the vascular quality initiative

Abstract

ObjectivesDespite guidelines endorsing statin and single antiplatelet therapy (SAPT) therapy post-carotid endarterectomy (CEA), these medications may be either under or inappropriately prescribed. We determined rates of new statin prescriptions as well as change in antiplatelet therapy (APT) regimen at discharge. We identified characteristics associated with these occurrences.DesignWe performed a retrospective Vascular Quality Initiative registry analysis of more than 125 000 patients who underwent CEA from 2013 to 2021.SettingThe Vascular Quality Initiative is a multicentre registry database including academic and community-based hospitals throughout the USA.ParticipantsPatients age≥18 years undergoing CEA with available statin and APT data (preprocedure and postprocedure) were included.Primary and secondary outcome measuresWe determined overall rates of statin and APT prescription at discharge. Multivariate logistic regression was used to determine clinical and demographic characteristics that were mostly associated with new statin prescription or changes in APT regimen at discharge.ResultsStudy participants were predominantly male (61%) and White (90%), with a mean age of 70.6±9.1. 13.1% of participants were not on statin therapy pre-CEA, and 48% of these individuals were newly prescribed one. Statin rates steadily increased throughout the study period: 36.2% in 2013 to 62% in 2021. A higher likelihood of new statin prescription was associated with non-race, diabetes, coronary heart disease, stroke, TIA and a non-elective indication. Older age, female gender, chronic obstructive pulmonary disease and prior carotid revascularisation were associated with a lower likelihood of new statin prescription. Nearly all participants were discharged on APT (63% SAPT and 37% dual antiplatelet therapy, DAPT). Among these individuals, 16% were discharged on a regimen that was different from the one on admission (11 947 (10.7%) of patients were upgraded to DAPT and 5813 (5.2%) were downgraded to SAPT).ConclusionsAlthough statin use has substantially improved following CEA, more than half of individuals not on a statin preprocedure remained this way at discharge. In addition, DAPT at discharge was frequent, a quarter of whom were on SAPT preprocedure. Further efforts are needed to improve rates of new statin prescriptions, ensure appropriate APT intensity at discharge and determine how different discharge APT regimens impact outcomes.