caa a22 4500 475824040 CHVBK 20180406123826.0 cr unu---uuuuu 170329e20000401xx s 000 0 eng 10.1023/A:1018706425864 doi (NATIONALLICENCE)springer-10.1023/A:1018706425864 Early and Pre-Discharge Aspirin Administration Among Patients with Acute Myocardial Infarction: Current Clinical Practice and Trends in the United States [Elektronische Daten] [Richard Becker, Maureen Burns, Joel Gore, Costas Lambrew, William French, William Rogers] Objectives: The purpose of our study was to determine the frequency of aspirin administration among patients with acute myocardial infarction (MI) as dictated by physicians practicing in the United States. Background: Aspirin (ASA), a widely available, inexpensive and generally well-tolerated platelet inhibitor, is recommended for patients with acute coronary syndromes, including acute MI. However, there is concern that aspirin is underutilized in daily clinical practice. Methods: Early (<24 hours) and predischarge ASA administration were determined among 220,171 patients with suspected acute MI enrolled in the Second National Registry of Myocardial Infarction (NRMI 2) between June, 1994 and April 30, 1996. Results: Overall, 165,122 (74.9%) of patients received ASA within 24 hours of hospital admission, whereas 55,049 patients did not. Early ASA recipients were younger, more often male, arrived at the hospital earlier, and were more likely to be classified as Killip Class II or less compared to those who did not receive ASA. Patients who received aspirin were also more likely to have chest pain, electrocardiographic ST segment elevation, and tended to arrive at the hospital earlier than those who did not receive ASA. However, over 20% of patients with ST segment elevation did not receive early ASA therapy. From the total cohort of early ASA recipients, only 69% received ASA at the time of hospital discharge. Trends in early and pre-discharge aspirin administration over a 2 year time period in all patients (72.6 to 75.1% and 71.5 to 74.6%, respectively; p < 0.001) and in specific patient subsets were encouraging with a gradual but steady increase; however, utilization remained comparatively low in women and the elderly. By multivariable analysis, in-hospital recurrent MI (OR 0.90, 95% CI; .78-1.0, p = 0.04), stroke (OR 0.65, 95% CI, .52-.80, p < 0.001) and death (OR 0.24, 95% CI, .22-.26, p < 0.001) occurred less frequently when ASA was administered within 24 hours of hospitalization. Conclusion: Aspirin is currently underutilized in routine clinical practice as both primary and adjunctive forms of therapy in MI, especially among patients known to be at risk for recurrent cardiothrombotic events. The targeted and timely use of aspirin reduces early cardiovascular events and should remain a priority in national health care efforts. Kluwer Academic Publishers, 2000 myocardial infarction nationallicence aspirin nationallicence national health care nationallicence Becker Richard Cardiovascular Thrombosis Research Center, University of Massachusetts Medical School, Worcester, MA aut Burns Maureen Cardiovascular Thrombosis Research Center, University of Massachusetts Medical School, Worcester, MA aut Gore Joel Cardiovascular Thrombosis Research Center, University of Massachusetts Medical School, Worcester, MA aut Lambrew Costas Maine Medical Center, Portland, ME aut French William Harbor-UCLA Medical Center, Torrance, CA aut Rogers William University of Alabama at Birmingham Medical Center, Birmingham, AL aut Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 9/3(2000-04-01), 207-215 0929-5305 9:3<207 2000 9 11239 https://doi.org/10.1023/A:1018706425864 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1023/A:1018706425864 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Becker Richard Cardiovascular Thrombosis Research Center, University of Massachusetts Medical School, Worcester, MA aut NATIONALLICENCE 700 1- Burns Maureen Cardiovascular Thrombosis Research Center, University of Massachusetts Medical School, Worcester, MA aut NATIONALLICENCE 700 1- Gore Joel Cardiovascular Thrombosis Research Center, University of Massachusetts Medical School, Worcester, MA aut NATIONALLICENCE 700 1- Lambrew Costas Maine Medical Center, Portland, ME aut NATIONALLICENCE 700 1- French William Harbor-UCLA Medical Center, Torrance, CA aut NATIONALLICENCE 700 1- Rogers William University of Alabama at Birmingham Medical Center, Birmingham, AL aut NATIONALLICENCE 773 0- Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 9/3(2000-04-01), 207-215 0929-5305 9:3<207 2000 9 11239 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer