Antithrombotic and antihypertensive management 3 months after ischemic stroke - A prospective study in an inner city population
Antithrombotic and antihypertensive management 3 months after ischemic stroke - A prospective study in an inner city population
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DOI：
10.1161/01.str.31.2.469
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发表时间：
2000-02-01
期刊：
影响因子：
8.3
通讯作者：
Wolfe, CDA
中科院分区：
文献类型：
--
作者：
Hillen, T;Dundas, R;Wolfe, CDA
背景和目的-我们试图研究缺血性stroke. Methods-以人群为基础的南伦敦社区Strobe登记处前瞻性收集了1995年至1997年首次在一生中中风的数据。在缺血性卒中登记的患者中，在事件发生后3个月检查抗血栓形成和抗高血压治疗的治疗状态。结果在457例缺血性卒中患者的队列中，393例（86.0%）被认为适合抗血小板药物治疗，32例（7.0%）抗凝药物治疗，254例（55.9%）抗高血压药物治疗。事件发生后3个月观察到的未治疗率为抗血小板药物24.4%，抗凝剂59.4%，抗高血压药物29.5%。未接受抗血栓治疗（抗血小板和抗凝剂）的独立风险因素为卒中亚型（非腔隙性梗死：OR=1.60，95% CI 1.07 - 2.54）、通过格拉斯哥昏迷量表（GCS）评分测量的卒中严重程度（GCS小于或等于13。OR 2.08，95%CI 1.18 ~ 3.66）和事件后5天的Barthel指数（Bf）评分（BI小于或等于10：OR 1.85，95% CI 1.17 - 2.93），对于降压治疗，（OR 2.46，95% CI 1.33 - 4.54），GCS评分（OR 2.97，95% CI 1.35 - 6.53），BI评分（OR 2.33，95% CI 1.27 - 4.29）和种族（白人：OR 2.43，95% CI 1.15 - 5.14）与未治疗独立相关。考克斯回归模型显示，治疗状态和无复发的3年生存率之间没有显着的关联后，控制中风的严重程度和亚型。医疗保健专业人员需要考虑对所有卒中患者进行抗血栓和抗高血压治疗。
Background and Purpose-We sought to examine the frequency, predictors, and effects of nontreatment with antithrombotic and antihypertensive therapies 3 months after ischemic stroke.Methods-The population-based South London Community Strobe Register prospectively collected data on first-in-a-lifetime strokes between 1995 and 1997. Among patients registered with ischemic stroke, treatment status with antithrombotic and antihypertensive therapies was examined 3 months after the event.Results-In a cohort of 457 patients with ischemic stroke, 393 (86.0%) were considered appropriate for antiplatelet medication, 32 (7.0%) for anticoagulant medication, and 254 (55.9%) for antihypertensive medication. The rates of nontreatment observed 3 months after the event were 24.4% for antiplatelet, 59.4% for anticoagulant, and 29.5% for antihypertensive medication. Independent risk factors for nontreatment with antithrombotic therapies (antiplatelets and anticoagulants) were the subtype of stroke (nonlacunar infarct: OR=1.60, 95% CI 1.07 to 2.54), stroke severity measured by the Glasgow Coma Scale (GCS) score (GCS less than or equal to 13. OR 2.08, 95% CI 1.18 to 3.66) and the Barthel Index (Bf) score 5 days after the event (BI less than or equal to 10: OR 1.85, 95% CI 1.17 to 2.93), For antihypertensive therapies the stroke subtype (OR 2.46, 95% CI 1.33 to 4.54), GCS score (OR 2.97, 95% CI 1.35 to 6.53), BI score (OR 2.33, 95% CI 1.27 to 4.29), and ethnicity (Caucasian: OR 2.43, 95% CI 1.15 to 5.14) were independently associated with nontreatment. Cox regression modeling showed no significant association between the treatment status and recurrence-free 3-year survival rates after controlling for severity and subtype of stroke.Conclusions-Secondary prevention for a common disease such as stroke appears to be inadequate in the study area. Healthcare professionals need to consider antithrombotic and antihypertensive therapies for all stroke patients.