Sluggett Janet K, Caughey Gillian E, Ward Michael B, Gilbert Andrew L
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
Int J Clin Pharm. 2015 Oct;37(5):782-9. doi: 10.1007/s11096-015-0115-2. Epub 2015 Apr 29.
Guidelines recommend patients diagnosed with transient ischaemic attack (TIA) or ischaemic stroke receive antihypertensive, antithrombotic and lipid lowering medicines. Reassessment of the need for medicines associated with an increased risk of stroke is also recommended.
To determine changes in the use of medicines recommended for secondary stroke prevention, medicines commonly used for treating stroke-related complications and medicines not recommended for use after ischaemic stroke, and to determine patient characteristics associated with use of all three stroke prevention medicines after TIA or ischaemic stroke. Setting Administrative health claims data from the Australian Government Department of Veterans' Affairs.
This retrospective study included patients with a first-ever hospitalisation for TIA or ischaemic stroke in 2009 and alive at 4 months after discharge. Changes to medicines dispensed in the 4 months before and after hospitalisation were compared using McNemar's test. Log binomial regression analysis was used to determine patient characteristics associated with use of all three secondary stroke prevention medicines after hospitalisation for TIA or ischaemic stroke.
Prevalence of medicine use after hospitalisation.
1541 patients (853 TIA, 688 ischaemic stroke) were included, with a median age of 85 years. High use of antihypertensive (82% TIA, 86 % ischaemic stroke) and antithrombotic (84% TIA, 90% ischaemic stroke) medicines was observed postdischarge, with 58% of TIA and 73% of ischaemic stroke patients receiving lipid lowering therapy. Half of the population (47% TIA, 61% ischaemic stroke) were dispensed all three classes of medicines recommended for secondary stroke prevention after discharge. Ischaemic stroke patients, younger patients, patients with more comorbid conditions and those discharged home were more likely to receive all three recommended medicine classes. Antibiotics (45% TIA, 46% ischaemic stroke), paracetamol (44% TIA, 47% ischaemic stroke), antidepressants (26% TIA, 31% ischaemic stroke) and laxatives (24% TIA, 32% ischaemic stroke) were commonly used after discharge. Increased use of sedatives and reduced use of non-steroidal anti-inflammatories was also observed after discharge.
Changes to pharmacotherapy after TIA or ischaemic stroke were consistent with treatment for stroke risk factors and common stroke-related complications. Use of secondary stroke prevention medicines may be further improved among TIA patients.
指南建议，被诊断为短暂性脑缺血发作（TIA）或缺血性中风的患者应服用抗高血压药、抗血栓药和降脂药。还建议重新评估使用与中风风险增加相关药物的必要性。
确定用于二级中风预防的推荐药物、常用于治疗中风相关并发症的药物以及缺血性中风后不建议使用的药物的使用变化，并确定与TIA或缺血性中风后使用所有三种中风预防药物相关的患者特征。数据来源为澳大利亚政府退伍军人事务部的行政健康索赔数据。
这项回顾性研究纳入了2009年首次因TIA或缺血性中风住院且出院后4个月仍存活的患者。使用McNemar检验比较住院前后4个月内所配药物的变化。采用对数二项回归分析来确定与TIA或缺血性中风住院后使用所有三种二级中风预防药物相关的患者特征。
出院后药物使用的患病率。
共纳入1541例患者（853例TIA，688例缺血性中风），中位年龄为85岁。出院后观察到抗高血压药（TIA患者中为82%，缺血性中风患者中为86%）和抗血栓药（TIA患者中为84%，缺血性中风患者中为90%）的使用率较高，58%的TIA患者和73%的缺血性中风患者接受了降脂治疗。一半的患者（TIA患者中为47%，缺血性中风患者中为61%）出院后被配给了推荐用于二级中风预防的所有三类药物。缺血性中风患者、年轻患者、合并症更多的患者以及出院回家的患者更有可能接受所有三类推荐药物。出院后常用抗生素（TIA患者中为45%，缺血性中风患者中为46%）、对乙酰氨基酚（TIA患者中为44%，缺血性中风患者中为47%）、抗抑郁药（TIA患者中为26%，缺血性中风患者中为31%）和泻药（TIA患者中为24%，缺血性中风患者中为32%）。出院后还观察到镇静剂使用增加而非甾体抗炎药使用减少。
TIA或缺血性中风后药物治疗的变化与中风危险因素及常见中风相关并发症的治疗一致。TIA患者二级中风预防药物的使用可能有待进一步改善。
