Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Republic of Singapore.
CNS Drugs. 2019 Aug;33(8):791-815. doi: 10.1007/s40263-019-00648-w.
Drug utilization and outcomes research in multi-ethnic Asian stroke populations is lacking.
Our objective was to examine temporal trends and predictors of drug utilization and outcomes in a multi-ethnic Asian stroke population.
This registry-based study included ischemic and hemorrhagic first-ever stroke patients hospitalized between 2009 and 2016. Utilization of medications included in-hospital thrombolytic agents, early antithrombotics (antiplatelets, anticoagulants) within 48 h of admission, and antithrombotics and statins at discharge. Outcomes analyzed were in-hospital all-cause mortality; 28-day, 90-day, and 1-year case fatality (CF); and discharge destination.
Of the 36,615 included patients, 81.6% had ischemic stroke and 18.4% had hemorrhagic stroke (15.5% intracerebral hemorrhage [ICH] and 2.8% subarachnoid hemorrhage [SAH]). For ischemic stroke, the combined use of all three guideline medications (in-hospital thrombolytic therapy, as well as antithrombotics and statins at discharge) increased (P = 0.006). Being on the stroke pathway was associated with prescription of all three guideline medications in ischemic stroke. Decreasing trends for in-hospital mortality, 28-day, 90-day, and 1-year CF and proportion of patients discharged home without rehabilitation appointment were observed in ischemic stroke (P < 0.05) but not in ICH or SAH (apart from 28-day CF). Ischemic stroke patients who received guideline medications were less likely to die or be discharged to nursing homes and chronic sick hospitals. Hemorrhagic stroke patients prescribed statins at discharge were less likely to have 28-day and 1-year CF.
Prescription of secondary stroke preventive medications (particularly in ischemic stroke) was associated with more favorable outcomes, highlighting the importance of physician adherence to evidence-based pharmacotherapy.
多民族亚洲人群中风患者的药物使用和结局研究较为缺乏。
我们旨在研究多民族亚洲中风人群中药物使用和结局的时间趋势和预测因素。
本基于登记的研究纳入了 2009 年至 2016 年期间住院的首次缺血性和出血性中风患者。使用的药物包括住院溶栓药物、入院后 48 小时内的早期抗血栓药物（抗血小板药物、抗凝药物）以及出院时的抗血栓药物和他汀类药物。分析的结局包括住院期间全因死亡率；28 天、90 天和 1 年病死率（CF）；以及出院去向。
在纳入的 36615 例患者中，81.6%为缺血性中风，18.4%为出血性中风（15.5%为脑内出血[ICH]，2.8%为蛛网膜下腔出血[SAH]）。对于缺血性中风，三种指南药物（住院溶栓治疗以及出院时的抗血栓药物和他汀类药物）的联合使用有所增加（P=0.006）。走中风治疗路径与缺血性中风患者使用三种指南药物有关。缺血性中风患者的住院死亡率、28 天、90 天和 1 年 CF 以及未预约康复治疗即出院的患者比例呈下降趋势（P<0.05），但 ICH 或 SAH 则不然（28 天 CF 除外）。接受指南药物治疗的缺血性中风患者死亡或出院至疗养院和慢性病医院的可能性较小。出院时开具他汀类药物的出血性中风患者 28 天和 1 年 CF 的可能性较低。
二级预防中风药物的处方（尤其是缺血性中风）与更好的结局相关，这突出了医生坚持循证药物治疗的重要性。
