Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
Ann Acad Med Singap. 2020 Mar;49(3):137-154.
Data on drug utilisation among stroke patients of Asian ethnicities are lacking. The objectives of the study were to examine the temporal trends and patient characteristics associated with prescription of thrombolytic, antithrombotic and statin medications among patients with first-ever stroke.
First-ever ischaemic and haemorrhagic stroke patients admitted to 2 Singapore tertiary hospitals between 2010‒2014 were included. Data were extracted from the National Healthcare Group Chronic Disease Management System. Association between drug utilisation and admission year, as well as characteristics associated with drug use, were explored using multivariable logistic regression.
There was an increasing trend in the combined use of all 3 guideline medications in ischaemic stroke patients ( <0.001)-specifically thrombolytic agents ( <0.001), oral antithrombotics ( = 0.002) and statins ( = 0.003) at discharge. Among antithrombotics, the use of clopidogrel ( <0.001) and aspirin-clopidogrel ( <0.001) had increased, whereas prescription of dipyridamole ( <0.001) and aspirin-dipyridamole ( <0.001) had declined. For statins, the increase in atorvastatin prescription ( <0.001) was accompanied by decreasing use of simvastatin ( <0.001). Age, ethnicity and certain comorbidities (hyperlipidaemia, atrial fibrillation and chronic kidney disease) were associated with the combined use of all 3 guideline medications ( <0.05). In haemorrhagic stroke, prescription of statins at discharge were comparatively lower.
This study reveals changes in prescription behaviour over time in a multiethnic Asian population with first-ever stroke. Patient characteristics including younger age, Malay ethnicity and certain comorbidities (i.e. hyperlipidaemia, atrial fibrillation) were associated with the combined use of all 3 guideline medications among ischaemic stroke patients.
亚洲族裔中风患者的药物使用数据尚不清楚。本研究的目的是研究首次中风患者中溶栓、抗血栓和他汀类药物处方与时间趋势和患者特征的关系。
纳入了 2010 年至 2014 年期间在新加坡 2 家三级医院住院的首次缺血性和出血性中风患者。数据从国家医疗保健集团慢性病管理系统中提取。使用多变量逻辑回归分析药物使用与入院年份之间的关系以及与药物使用相关的特征。
在缺血性中风患者中，所有 3 种指南药物联合使用呈上升趋势（<0.001）-特别是溶栓药物（<0.001）、口服抗血栓药物（=0.002）和他汀类药物（=0.003）在出院时。在抗血栓药物中，氯吡格雷（<0.001）和阿司匹林-氯吡格雷（<0.001）的使用增加，而双嘧达莫（<0.001）和阿司匹林-双嘧达莫（<0.001）的处方减少。对于他汀类药物，阿托伐他汀处方的增加（<0.001）伴随着辛伐他汀的使用减少（<0.001）。年龄、族裔和某些合并症（高脂血症、心房颤动和慢性肾脏病）与所有 3 种指南药物的联合使用相关（<0.05）。在出血性中风中，出院时他汀类药物的处方相对较低。
本研究揭示了在一个多族裔亚洲首次中风人群中，随着时间的推移，处方行为发生了变化。患者特征，包括年龄较小、马来族裔和某些合并症（即高脂血症、心房颤动）与缺血性中风患者中所有 3 种指南药物的联合使用相关。
