Antiplatelet therapy trends in Chinese ischemic stroke patients 2019–2024

Abstract

Abstract 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.