Use of antithrombotic medications among elderly ischemic stroke patients.
Use of antithrombotic medications among elderly ischemic stroke patients.
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DOI：
10.1161/circoutcomes.109.850883
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发表时间：
2011-01-01
期刊：
影响因子：
--
通讯作者：
Goldstein LB
中科院分区：
文献类型：
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作者：
Lichtman JH;Naert L;Allen NB;Watanabe E;Jones SB;Barry LC;Bravata DM;Goldstein LB
The use of antithrombotic medications after ischemic stroke is recommended for deep vein thrombosis (DVT) prophylaxis and secondary stroke prevention. We assessed the rate of receipt of these therapies among eligible ischemic stroke patients aged ≥65 years and determined the effects of age and other patient characteristics on treatment. The analysis included Medicare fee-for-service beneficiaries discharged with ischemic stroke (ICD-9 433, 434, 436) randomly selected for inclusion in the Medicare Health Care Quality Improvement Program’s National Stroke Project 1998–1999, 2000–2001. Patients discharged from non-acute facilities, transferred, or terminally ill were excluded. Receipt of in-hospital pharmacological DVT prophylaxis, antiplatelet medication, anticoagulants for atrial fibrillation, and antithrombotic medications at discharge were assessed in eligible patients, stratified by age (65–74, 75–84, 85+ yrs). Descriptive models identified characteristics associated with treatment. Among 31,554 patients, 14.9% of those eligible received pharmacologic DVT prophylaxis, 83.9% antiplatelet drugs, 82.8% anticoagulants for atrial fibrillation, and 74.2% were discharged on an antithrombotic medication. Rates of treatment decreased with age, and were lowest for patients aged 85 years or older. Admission from a skilled nursing facility and functional dependence were associated with lower treatment rates. There was substantial underuse of antithrombotic therapies among elderly ischemic stroke patients, particularly among the very elderly, those admitted from skilled nursing facilities, and patients with functional dependence. The reasons for low use of antithrombotic therapies, including the apparent underuse of DVT prophylaxis in otherwise eligible patients, require further investigation.
