Real-World Postdischarge P2Y12 Inhibitor Use After Ischemic Stroke and Transient Ischemic Attack, 2020 to 2024.

BACKGROUND

P2Y12 inhibitor acquisition and continuation after ischemic stroke or transient ischemic attack (TIA) are incompletely characterized.

OBJECTIVE

To describe postdischarge clopidogrel and ticagrelor uptake, persistence, switching, bleeding diagnoses, and trends.

METHODS

This retrospective descriptive cohort study used US claims (2020-2025). Adults with a first qualifying inpatient ischemic stroke or inpatient/emergency-department TIA from July 2020 through December 2024 were included. Fills were assessed through 90 days. Persistence and 1-year bleeding diagnoses were evaluated among continuously enrolled initiators; switching was assessed through follow-up of 365 days.

RESULTS

Among 45 763 patients, 8667 (18.9%) filled a P2Y12 inhibitor within 30 days: 8226 clopidogrel (94.9% of initiators) and 441 ticagrelor (5.1%). Among 5641 continuously enrolled initiators, clopidogrel versus ticagrelor persistence was 66.3% versus 78.3% at day 90 and 50.5% versus 59.6% at day 180; it was low for both at day 365. Switching occurred in 2.9%; 23.8% of ticagrelor initiators later filled clopidogrel versus 1.7% in the reverse direction. Crude 1-year intracerebral hemorrhage and gastrointestinal bleeding diagnosis rates were 2.6% and 5.8%. Overall uptake rose from 18.3% in July to December 2020 to 20.9% in 2024. Claims did not reliably capture over-the-counter aspirin, clinical eligibility, ingestion, or reasons for changes.

CONCLUSION AND RELEVANCE: Fewer than 1 in 5 adults with coded ischemic stroke or TIA filled a P2Y12 inhibitor within 30 days. These data benchmark outpatient acquisition and persistence, not guideline adherence or comparative effectiveness.