(Stroke. 2000;31:469.)
© 2000 American Heart Association, Inc.
Original Contributions |
Antithrombotic and Antihypertensive Management 3 Months After Ischemic Stroke
A Prospective Study in an Inner City Population
From the Division of Primary Care and Public Health Sciences (T.H., R.D., E.L., J.A.S., C.D.A.W.), Guy’s, King’s and St Thomas’ School of Medicine, King’s College London, UK; and the Elderly Care Unit, Guy’s and St Thomas’ Hospital Trust, London, UK.
Correspondence to C. Wolfe, 5th Floor, Capital House, Guy’s Hospital, 42 Weston Street, London SE1 3QD, UK. E-mail charles.wolfe{at}kcl.ac.uk
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 
13: OR 2.08, 95%
CI 1.18 to 3.66) and the Barthel Index (BI) score 5 days after the
event (BI 10: OR 1.85, 95% CI 1.17 to 2.93). For antihypertensive
therapies the stroke subtype (OR 2.46, 95% CI 1.33 to 4.54), GCS score
(OR 2.97, 95% CI 1.35 to 6.53), BI score (OR 2.33, 95% CI 1.27 to
4.29), and ethnicity (Caucasian: OR 2.43, 95% CI 1.15 to 5.14) were
independently associated with nontreatment. Cox regression modeling
showed no significant association between the treatment status and
recurrence-free 3-year survival rates after controlling for
severity and subtype of stroke.
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.
Key Words: antithrombotic therapy • epidemiology • hypertension • prevention • stroke management
This article has been cited by other articles:
 |
|
 |
|
  E. Touze, J. Coste, M. Voicu, J. Kansao, R. Masmoudi, B. Doumenc, P. Durieux, and J.-L. Mas Importance of In-Hospital Initiation of Therapies and Therapeutic Inertia in Secondary Stroke Prevention: IMplementation of Prevention After a Cerebrovascular evenT (IMPACT) Study Stroke, June 1, 2008; 39(6): 1834 - 1843. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele, O. Drogan, W. J. Koroshetz, P. Fayad, and J. L. Saver Outpatient Practice Patterns After Stroke Hospitalization Among Neurologists Stroke, June 1, 2008; 39(6): 1850 - 1854. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Ramsay, P. H. Whincup, S. G. Wannamethee, O. Papacosta, L. Lennon, M. C. Thomas, and R. W. Morris Missed opportunities for secondary prevention of cerebrovascular disease in elderly British men from 1999 to 2005: a population-based study J. Public Health Med., September 1, 2007; 29(3): 251 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Levine, C. I. Kiefe, T. K. Houston, J. J. Allison, E. P. McCarthy, and J. Z. Ayanian Younger Stroke Survivors Have Reduced Access to Physician Care and Medications: National Health Interview Survey From Years 1998 to 2002 Arch Neurol, January 1, 2007; 64(1): 37 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Touze, J.-L. Mas, J. Rother, S. Goto, A. T. Hirsch, Y. Ikeda, C.-S. Liau, E. M. Ohman, A. J. Richard, P. W. F. Wilson, et al. Impact of Carotid Endarterectomy on Medical Secondary Prevention After a Stroke or a Transient Ischemic Attack: Results from the Reduction of Atherothrombosis for Continued Health (REACH) Registry Stroke, December 1, 2006; 37(12): 2880 - 2885. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. L. Paul and A. G. Thrift Control of Hypertension 5 Years After Stroke in the North East Melbourne Stroke Incidence Study Hypertension, August 1, 2006; 48(2): 260 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Kaplan, D. L. Tirschwell, W. T. Longstreth Jr, T. A. Manolio, S. R. Heckbert, D. Lefkowitz, A. El-Saed, and B. M. Psaty Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly Neurology, September 27, 2005; 65(6): 835 - 842. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele, N. K. Hills, J. L. Saver, and S. C. Johnston Antihypertensive Medications Prescribed at Discharge After an Acute Ischemic Cerebrovascular Event Stroke, September 1, 2005; 36(9): 1944 - 1947. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. McKevitt, C. Coshall, K. Tilling, and C. Wolfe Are There Inequalities in the Provision of Stroke Care?: Analysis of an Inner-City Stroke Register Stroke, February 1, 2005; 36(2): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele, J. L. Saver, A. Fredieu, S. Suzuki, S. Selco, V. Rajajee, N. McNair, T. Razinia, and C. S. Kidwell In-Hospital Initiation of Secondary Stroke Prevention Therapies Yields High Rates of Adherence at Follow-up Stroke, December 1, 2004; 35(12): 2879 - 2883. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. McKevitt, J. Redfern, F. Mold, and C. Wolfe Qualitative Studies of Stroke: A Systematic Review Stroke, June 1, 2004; 35(6): 1499 - 1505. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Hillen, S Davies, A G Rudd, T Kieselbach, and C D Wolfe Self ratings of health predict functional outcome and recurrence free survival after stroke J. Epidemiol. Community Health, December 1, 2003; 57(12): 960 - 966. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Fox Poststroke patients: implications for the cardiologist Eur. Heart J. Suppl., July 1, 2003; 5(suppl_E): E4 - E10. [Abstract] [PDF]
|
|
|
|
|
|
T. Hillen, C. Coshall, K. Tilling, A. G. Rudd, R. McGovern, and C. D.A. Wolfe Cause of Stroke Recurrence Is Multifactorial: Patterns, Risk Factors, and Outcomes of Stroke Recurrence in the South London Stroke Register Stroke, June 1, 2003; 34(6): 1457 - 1463. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Redfern, C. McKevitt, A. G Rudd, and C. D. Wolfe Health care follow-up after stroke: opportunities for secondary prevention Fam. Pract., August 1, 2002; 19(4): 378 - 382. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Gorelick Stroke Prevention Therapy Beyond Antithrombotics: Unifying Mechanisms in Ischemic Stroke Pathogenesis and Implications for Therapy: An Invited Review Stroke, March 1, 2002; 33(3): 862 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sappok, A. Faulstich, E. Stuckert, H. Kruck, P. Marx, and H.-C. Koennecke Compliance With Secondary Prevention of Ischemic Stroke: A Prospective Evaluation Stroke, August 1, 2001; 32(8): 1884 - 1889. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hajat, R. Dundas, J. A. Stewart, E. Lawrence, A. G. Rudd, R. Howard, and C. D. A. Wolfe Cerebrovascular Risk Factors and Stroke Subtypes : Differences Between Ethnic Groups Stroke, January 1, 2001; 32(1): 37 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Redfern, C. McKevitt, R. Dundas, A. G. Rudd, and C. D.A. Wolfe Behavioral Risk Factor Prevalence and Lifestyle Change After Stroke : A Prospective Study Stroke, August 1, 2000; 31(8): 1877 - 1881. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Underuse of Secondary Stroke Prevention in An Inner City Population Journal Watch Neurology, May 1, 2000; 2000(501): 9 - 9. [Full Text]
|
|