Hwong Wen Yea, Abdul Aziz Zariah, Sidek Norsima Nazifah, Bots Michiel L, Selvarajah Sharmini, Kappelle L Jaap, Sivasampu Sheamini, Vaartjes Ilonca
National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
BMC Neurol. 2017 Nov 23;17(1):203. doi: 10.1186/s12883-017-0984-1.
Evaluation of secondary stroke prevention in low and middle-income countries remains limited. This study assessed the prescription of secondary preventive drugs among ischemic stroke patients upon hospital discharge in Malaysia and identified factors related to the prescribing decisions.
From Malaysian National Stroke Registry, we included patients with non-fatal ischemic stroke. Prescriptions of antiplatelet, anticoagulants, antihypertensive drugs and lipid-lowering drugs were assessed. Multi-level logistic regressions were performed to determine the relation between potential factors and drug prescriptions.
Of 5292 patients, 48% received antihypertensive drugs, 88.9% antiplatelet and 88.7% lipid-lowering drugs upon discharge. Thirty-three percent of patients with an indication for anticoagulants (n = 391) received it. Compared to patients <=50 years, patients above 70 years were less likely to receive antiplatelet (OR: 0.72, 95% CI: 0.50-1.03), lipid-lowering drugs (OR: 0.66, 95% CI: 0.45-0.95) and anticoagulants (OR: 0.27, 95% CI: 0.09-0.83). Patients with moderate to severe disability upon discharge had less odds of receiving secondary preventive drugs; an odds ratio of 0.57 (95% CI: 0.45-0.71) for antiplatelet, 0.86 (95% CI: 0.75-0.98) for antihypertensive drugs and 0.78 (95% CI: 0.63-0.97) for lipid-lowering drugs in comparison to those with minor disability. Having prior specific comorbidities and drug prescriptions significantly increased the odds of receiving these drugs. No differences were found between sexes and ethnicities.
Prescription of antihypertensive drugs and anticoagulants among ischemic stroke patients in Malaysia were suboptimal. Efforts to initiate regular clinical audits to evaluate the uptake and effectiveness of secondary preventive strategies are timely in low and middle-income settings.
中低收入国家对二级卒中预防的评估仍然有限。本研究评估了马来西亚缺血性卒中患者出院时二级预防药物的处方情况，并确定了与处方决策相关的因素。
从马来西亚国家卒中登记处纳入非致命性缺血性卒中患者。评估抗血小板药物、抗凝药物、降压药物和降脂药物的处方情况。进行多水平逻辑回归以确定潜在因素与药物处方之间的关系。
5292例患者中，48%出院时接受了降压药物，88.9%接受了抗血小板药物，88.7%接受了降脂药物。有抗凝指征的患者（n = 391）中，33%接受了抗凝治疗。与50岁及以下患者相比，70岁以上患者接受抗血小板药物（比值比：0.72，95%置信区间：0.50 - 1.03）、降脂药物（比值比：0.66，95%置信区间：0.45 - 0.95）和抗凝药物（比值比：0.27，95%置信区间：0.09 - 0.83）的可能性较小。出院时中度至重度残疾的患者接受二级预防药物的几率较低；与轻度残疾患者相比，抗血小板药物的比值比为0.57（95%置信区间：0.45 - 0.71），降压药物为0.86（95%置信区间：0.75 - 0.98），降脂药物为0.78（95%置信区间：0.63 - 0.97）。有先前特定合并症和药物处方显著增加了接受这些药物的几率。性别和种族之间未发现差异。
马来西亚缺血性卒中患者中降压药物和抗凝药物的处方情况不理想。在中低收入环境中，及时开展定期临床审计以评估二级预防策略的采用情况和有效性是很有必要的。
