To Örebro University

BACKGROUND: Antithrombotic therapy constitutes a critical part of stroke management, and its utilization serves as an important indicator in the assessment of stroke care. However, knowledge on how the pandemic influenced the antithrombotic utilization after stroke remains limited.

OBJECTIVE: This study aims to investigate the impact of the COVID-19 pandemic on the initiation of antithrombotic agents after stroke in Sweden.

DESIGN: Using nationwide linked Swedish health registers, we conducted an interrupted time series analysis (ITSA) using generalized linear model (binomial distribution, logit link). We estimated monthly trends in the initiation of antithrombotic drugs among new stroke patients between January 2019 and April 2024, with the pandemic intervention point set in March 2020.

KEY RESULTS: The monthly number of stroke cases declined significantly by 107 cases per month. No significant changes were observed in the total antithrombotic initiation. Antiplatelets showed a significant pre-pandemic increasing trend (OR = 1.011 per month, 95% CI: 1.003 to 1.020), an immediate level increase at onset (OR = 1.150, 95% CI: 1.067 to 1.259) and a post-intervention decline (OR = 0.991 per month, 95% CI: 0.981 to 0.998). Factor Xa inhibitors use increased post-intervention (OR = 1.004, 95% CI: 1.002 to 1.006), while warfarin (OR = 0.990, 95% CI: 0.981 to 0.999) and dabigatran (OR = 0.991, 95% CI: 0.986 to 0.997) decreased.

CONCLUSIONS: The COVID-19 pandemic had no impact on the overall use of antithrombotic agents. However, a short-term increase in antiplatelet initiation and long-term changes in warfarin, dabigatran, and factor Xa initiations were observed after the COVID-19 outbreak.

BACKGROUND: Adequate postoperative pain treatment is important for quality of life, patient satisfaction, rehabilitation, function, and total opioid consumption, and might lower both the risk of chronic postoperative pain and the costs for society. Prolonged opioid consumption is a well-known risk factor for addiction. Previous studies in upper extremity surgery have shown that total opioid consumption is a third of the amount prescribed, which can be explained by package size. The aim of this study was to examine whether implementation of prepacked takehome analgesia bags reduced the quantity of prescribed and dispensed opioids.

MATERIAL AND METHODS: We introduced prepacked take-home analgesia bags for postoperative pain treatment in outpatient surgery. The bags came in two sizes, each containing paracetamol, etoricoxib, and oxycodone. The first 147 patients who received the prepacked analgesia bags were included in the study, and received a questionnaire one month after surgery covering self-assessed pain (visual analog scale of 0-10) and satisfaction (0-5), as well as opioid consumption. Prescription data after introducing the analgesia bags were compared with data before the bags were introduced.

RESULTS: Of the 147 patients included in the study, 58 responded. Compared to standard prescription (small bag group: 14 oxycodone immediate release capsules (5 mg), large bag group: additional 28 oxycodone extended release tablets (5 mg), based on the smallest available package), the patients in the small analgesia bag group received 50% less oxycodone and 67% less for the large bag group. Patients with small bags consumed a median of 0.0 mg oxycodone and those with large bags consumed a median of 25.0 mg oxycodone. The median satisfaction was 5.0 (range: 2-5) and the median pain score was acceptable at the first postoperative day. Prescription data showed a significant reduction of 60.0% in the total amount of prescribed opioids after the introduction of prepacked analgesia bags.

CONCLUSIONS: The introduction of prepacked analgesia bags dramatically reduced the quantity of opioids prescribed after outpatient hand surgery. Patient satisfaction was high and the postoperative pain level was acceptable.

PURPOSE: Hypertension is an important risk factor for severe outcomes in patients with COVID-19, and antihypertensive drugs may have a protective effect. However, the pandemic may have negatively impacted health care services for chronic diseases. The aim of this study was to assess initiations of antihypertensive medicines in patients infected by COVID-19.

METHODS: A cohort study including all Swedish residents 20-80 years old with a COVID-19 positive test compared with an unexposed group without COVID-19 matched for age, sex, and index date (date of confirmed COVID-19). Data were collected within SCIFI-PEARL, a study including linked data on COVID tests, hospital diagnoses, dispensed prescriptions, and socioeconomic data from Swedish national registers. Initiations of different antihypertensive drugs were studied from March 2020 until October 2020. Associations between COVID-19 and initiation of antihypertensives were assessed by a multivariable Cox proportional hazards model.

RESULTS: A total of 224 582 patients (exposed and unexposed) were included. After adjusting for cardiovascular comorbidities and education level, ACEi was the most commonly initiated antihypertensive agent to patients with COVID-19. Hazard ratio and 95% confidence interval for initiation of drug therapy was 1.83 [1.53-2.19] for ACEi, followed by beta-blockers 1.74 [1.55-1.95], calcium channel blockers 1.61 [1.41-1.83], angiotensin receptor blockers 1.61 [1.40-1.86], and diuretics 1.53 [1.32-1.77].

CONCLUSION: All antihypertensive medicines were initiated more frequently in COVID-19 patients. This can either be associated with hypertension caused by the COVID-19 infection, more frequent diagnosis of hypertension among people with COVID-19 since they consult health care, or residual confounding factors not adjusted for in the study.