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Drug therapy persistence and stroke recurrence

Fadia T Shaya1, Antoine C El Khoury, C Daniel Mullins

  • 1Department of Epidemiology and Preventive Medicine, University of Maryland, 515 West Lombard St, Baltimore, MD 21201, USA. fshaya@rx.umaryland.edu

The American Journal of Managed Care
|June 8, 2006
PubMed

Insights

Consistent use of stroke medications like warfarin, aspirin, or clopidogrel significantly reduces stroke recurrence risk. However, conditions such as heart disease and hypertension increase recurrence likelihood.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Stroke recurrence is a significant concern, particularly in high-risk populations.
  • Understanding medication adherence impact on secondary stroke prevention is crucial.

Purpose of the Study:

  • To evaluate the effect of persistent use of warfarin, aspirin, or clopidogrel on stroke recurrence.
  • To analyze these effects in a Medicaid population characterized by high risk, female predominance, and African American ethnicity.

Main Methods:

  • A prospective, non-concurrent cohort study utilizing longitudinal medical and pharmacy claims data.
  • Cox proportional hazards models and propensity scores were employed to analyze medication persistence and adjust for confounding factors.

Main Results:

  • Persistence in using warfarin, aspirin, or clopidogrel was associated with an increased likelihood of avoiding stroke recurrence (HR, 1.57; 95% CI, 1.22-2.01).
  • Initial hemorrhagic stroke, heart disease, hypertension, and diabetes mellitus were significantly associated with a decreased likelihood of avoiding recurrence.

Conclusions:

  • Sustained use of initial stroke-preventive medications is effective in preventing recurrent strokes.
  • Certain comorbidities and stroke types (hemorrhagic) are significant risk factors for stroke recurrence.
Abstract

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