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Antithrombotic and antihypertensive management 3 months after ischemic stroke : a prospective study in an inner city
T Hillen1, R Dundas, E Lawrence
1Division of Primary Care and Public Health Sciences, Guy's, King's and St Thomas' School of Medicine, King's College London, UK.
Insights
Secondary stroke prevention is inadequate, with significant undertreatment of antithrombotic and antihypertensive therapies. Healthcare providers must ensure all ischemic stroke patients receive appropriate secondary prevention medications.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Ischemic stroke is a leading cause of death and disability worldwide.
- Secondary prevention strategies are crucial in reducing stroke recurrence and improving patient outcomes.
- Antithrombotic and antihypertensive therapies are cornerstones of secondary stroke prevention.
Purpose of the Study:
- To investigate the frequency of undertreatment with antithrombotic and antihypertensive therapies.
- To identify predictors associated with the nontreatment of these essential medications.
- To evaluate the effects of treatment status on long-term stroke recurrence and survival.
Main Methods:
- Utilized data from the population-based South London Community Stroke Register (1995-1997).
- Prospectively collected data on first-ever ischemic stroke events.
- Examined treatment status for antithrombotic and antihypertensive therapies at 3 months post-stroke.
Main Results:
- High rates of nontreatment observed: 24.4% for antiplatelets, 59.4% for anticoagulants, and 29.5% for antihypertensives.
- Stroke subtype, severity (Glasgow Coma Scale), and functional status (Barthel Index) predicted nontreatment.
- Caucasian ethnicity was also associated with undertreatment for antihypertensive therapies.
- No significant association found between treatment status and 3-year recurrence-free survival after adjusting for stroke severity and subtype.
Conclusions:
- Secondary stroke prevention appears inadequate in the studied population.
- Healthcare professionals must prioritize antithrombotic and antihypertensive therapies for all ischemic stroke patients.
- Addressing undertreatment is vital for improving secondary stroke prevention and patient outcomes.
Background And Purpose:
We sought to examine the frequency, predictors, and effects of nontreatment with antithrombotic and antihypertensive therapies 3 months after ischemic stroke.
Methods:
The population-based South London Community Stroke Register prospectively collected data on first-in-a-lifetime strokes between 1995 and 1997. Among patients registered with ischemic stroke, treatment status with antithrombotic and antihypertensive therapies was examined 3 months after the event.
Results:
In a cohort of 457 patients with ischemic stroke, 393 (86.0%) were considered appropriate for antiplatelet medication, 32 (7.0%) for anticoagulant medication, and 254 (55.9%) for antihypertensive medication. The rates of nontreatment observed 3 months after the event were 24.4% for antiplatelet, 59.4% for anticoagulant, and 29.5% for antihypertensive medication. Independent risk factors for nontreatment with antithrombotic therapies (antiplatelets and anticoagulants) were the subtype of stroke (nonlacunar infarct: OR=1. 60, 95% CI 1.07 to 2.54), stroke severity measured by the Glasgow Coma Scale (GCS) score (GCS
Conclusions:
Secondary prevention for a common disease such as stroke appears to be inadequate in the study area. Healthcare professionals need to consider antithrombotic and antihypertensive therapies for all stroke patients.