Antiplatelet therapy trends in Chinese ischemic stroke patients 2019–2024

To analyze the current status and trends of antiplatelet medication use among ischemic stroke (IS) patients in China. This cross-sectional study utilized data from the China Hospital Prescription Analysis Database (2019-2024), analyzing 1,505,850 prescriptions. Mann-Kendall tests were employed to analyze the trends of prescriptions and cost, while log-linear models assessed changes in medication proportions. Defined daily cost (DDC) was calculated to evaluate economic differences. Among 1,505,850 prescriptions analyzed, 63.5% were for male patients, and 64.6% were for patients aged 65 and older. The patients median age of the prescriptions were 69 years (IQR: 61-78).Total antiplatelet prescriptions increased significantly from 300,573 in 2019 to 336,142 in 2024 (P = 0.024). Aspirin remained predominant (52.7%), while clopidogrel use declined significantly (46.6% to 40.9%, P = 0.002). Ticagrelor and indobufen showed rapid growth (both P < 0.001). Significant economic variations were observed: aspirin had the lowest DDC (¥0.57/DDD), while clopidogrel (¥3.60/DDD) and ticagrelor (¥6.61/DDD) decreased post-national centralized volume-based procurement policy (P < 0.001). Regional disparities were notable, with Zhengzhou (P < 0.001) and Hangzhou (P = 0.008) showing the fastest growth, while Tianjin (P < 0.001) and Shanghai (P = 0.003) declined significantly. Cilostazol demonstrated 104% regional DDC variation (Shenyang ¥16.96/DDD vs. Harbin ¥8.29/DDD). Antiplatelet prescription counts in Chinese IS patients increased in the past five years, with aspirin remaining the most widely used and cost-effective option. The treatment landscape shows "traditional drug dominance with new drug growth", marked by significant economic and regional variations, necessitating guideline-aligned and policy-informed optimization of medication strategies.