ABSTRACT NUMBER: ESOC2026A1430 MEDICATION PATTERNS BY STROKE SEVERITY IN NON-CARDIOEMBOLIC ISCHAEMIC STROKE: FINDINGS FROM A LARGE, NATIONALLY REPRESENTATIVE US-BASED RETROSPECTIVE OBSERVATIONAL DATABASE

Abstract Background and aims For non-cardioembolic ischaemic stroke (NCIS), real-world data on treatment patterns and adherence across severity levels are limited. We assessed inpatient and discharge treatment patterns overall and by NCIS severity. Methods This retrospective cohort study used EHRs from a large US database (Truveta) and included adults hospitalised with a first NCIS between 01/2017–12/2023. Stroke severity (NIHSS) was determined from structured data and clinical notes using a large language model. Medication data included inpatient administrations and outpatient prescriptions/dispenses, with dispense data obtained from SureScripts. Results Among 180,021 patients with NCIS (mean age, 68 years; 49.3% female), 67.2% had estimable admission NIHSS scores (≤5: 78%; 6–15: 14%; >15: 8%). During the index hospitalisation, 80.5% of patients received APT (SAPT, 51.8%; DAPT, 28.7%); aspirin was the most common SAPT agent, used in 49.1% of patients. Patients with NIHSS ≤5 had the highest proportion of inpatient total APT and DAPT use, whereas those with NIHSS >15 had the lowest use (Figure); SAPT use was similar across NIHSS categories. At discharge, 87.4% of patients received APT (SAPT, 51.3%; DAPT, 36.1%). SAPT use increased slightly with higher NIHSS scores, whereas DAPT use decreased markedly as NIHSS scores increased. Conclusions In this large, US representative, observational study of patients with NCIS, most received APT for secondary stroke prevention. However, DAPT was more frequently used in cases of milder stroke severity, while treatment use declined with increasing stroke severity. Further investigation is ongoing to clarify these treatment patterns. Conflict of interest This study was funded by Bayer AG. SS’s institution received compensation from Bayer. TNN reports serving as an Associate Editor of Stroke and consulting relationships with Bayer, Medtronic and Route92. MR declares no conflict of interest. AS reports research grants/contracts from AstraZeneca, Bayer, the Canadian Institutes of Health Research, Daiichi Sankyo Company, the Heart and Stroke Foundation of Canada, the National Institutes of Health, Octapharma USA, Inc. and Servier Affaires Medicales; has served on advisory boards for AstraZeneca, Bayer, Daiichi Sankyo Company and Takeda Pharmaceutical Company; and has served on a data and safety monitoring board for Bayer. MD and NT are employees of Truveta. SK, DRM, JX and KA are employees of Bayer. Table 1 - belongs to Conclusions