Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia.
Brain Behav. 2022 Oct;12(10):e2752. doi: 10.1002/brb3.2752. Epub 2022 Sep 6.
We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke.
We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle-Ottawa scale. Where possible, data were pooled using random-effects meta-analysis.
We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%-68%), and 68% (95% CI: 58%-79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%-93%). It was reported that 11% (95% CI: 2%-19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%-89%), 71% (95% CI: 57%-84%), and 73% (95% CI: 59%-86%), respectively.
In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.
本研究旨在调查卒中后抗血栓药物（包括抗凝剂和抗血小板药物）的处方情况和用药依从性。
我们对 MEDLINE 和 Embase 数据库进行了系统性文献检索，检索时间为 2015 年 1 月 1 日至 2022 年 2 月 17 日，以确定报告卒中后抗血栓药物（抗凝剂和抗血小板药物）处方情况的研究。两名研究者独立筛选纳入报告、提取数据，并根据 Newcastle-Ottawa 量表评估纳入研究的质量。如有可能，采用随机效应荟萃分析对数据进行汇总。
我们纳入了 46 项研究的 453625 例卒中患者。有房颤（AF）的患者中，抗血小板药物和抗凝剂的处方比例分别为 62%（95%CI：57%-68%）和 68%（95%CI：58%-79%）。四项研究中根据抗血栓药物指南建议治疗的患者比例为 67%（95%CI：41%-93%）。据报道，11%（95%CI：2%-19%）的患者未接受抗血栓药物治疗。抗血小板、抗凝和抗血栓药物的良好依从率分别为 78%（95%CI：67%-89%）、71%（95%CI：57%-84%）和 73%（95%CI：59%-86%）。
总之，我们发现，不到 70%的患者按照抗血栓药物推荐指南进行了处方和治疗，抗血栓药物的良好依从率仅为 73%。卒中幸存者的抗血栓药物处方率和良好依从率仍有待提高。
