Background: The use of antithrombotic medications after ischaemic stroke is recommended for deep vein thrombosis prophylaxis and secondary stroke prevention.  We assessed the rate of receipt of these therapies among eligible ischaemic stroke patients aged 65 years or older and determined the effects of age and other patient characteristics on treatment.

Methods and Results: The analysis included Medicare fee-for-service beneficiaries discharged with ischaemic stroke (ICD 433.x1, 434.x1, 436) randomly selected for inclusion in the Medicare Health Care Quality Improvement Program's National Stroke Project 1998 to 1999, 2000 to 2001.  Patients discharged from non-acute facilities, transferred or terminally ill were excluded.  Receipt of in-hospital pharmacological deep vein thrombosis prophylaxis, antiplatelet medication, anticoagulants for atrial fibrillation and antithrombotic medications at discharge were assessed in eligible patients, stratified by age (65-74, 75-84 and 85+ years).  Descriptive models identified characteristics associated with treatment.  Among 31 554 patients, 14.9% of those eligible received pharmacological deep vein thrombosis prophylaxis, 83.9% antiplatelet drugs, 82.8% anticoagulants for atrial fibrillation and 74.2% were discharged on an antithrombotic medication.  Rates of treatment decreased with age and were lowest for patients ages 85 years or older.  Admission from a skilled nursing facility and functional dependence were associated with lower treatment rates.

Conclusions: There was substantial underutilisation of antithrombotic therapies among elderly ischaemic stroke patients, particularly among the very elderly, those admitted from skilled nursing facilities, and patients with functional dependence.  The reasons for low use of antithrombotic therapies, including the apparent underutilisation of deep vein thrombosis prophylaxis in otherwise eligible patients, require further investigation.