Are stroke survivors taking their medicine?

December 04, 2009

People who have had an ischemic stroke are at higher lifetime risk for another stroke, but several types of medication can reduce that risk. One of the simplest regimens involves antithrombotic medications, otherwise known as blood thinners, of which the most common is aspirin.

But a new UCLA study to determine whether the use of antithrombotic medications among stroke survivors increased over a seven-year period found that in each of the years, approximately 20 percent of survivors were not taking these medications -- a figure that did not decrease during the time period. The study also found that individuals who were younger, female or Hispanic were less likely to be taking antithrombotic agents.

The findings appear in the January 2010 issue of the American Journal of Preventive Medicine.

"Prior studies have shown that nearly all stroke survivors receive such medications in the hospital," said lead author Dr. Eric M. Cheng, assistant professor of neurology at the David Geffen School of Medicine at UCLA and the Veterans Administration Greater Los Angeles Healthcare System. "However, it was not known whether stroke survivors continued to take this type of medication after they were discharged from the hospital."

Researchers analyzed data compiled from the annual Medical Expenditure Panel Survey (MEPS) from 2000 to 2006. In the seven annual MEPS data sets, 4,168 people reported having had a stroke. The study authors looked at the use of antithrombotic agents, which include aspirin (an antiplatelet), other antiplatelet medications and anticoagulants.

Pooling results across the seven years, the researchers found that 75 percent of the stroke survivors were using an antithrombotic agent -- with 66 percent reporting taking an antiplatelet medication and 57 percent taking aspirin. After excluding those individuals who reported not taking aspirin because it was unsafe for them, the researchers calculated that 81 percent were using antithrombotic agents.

The study authors also found that men, older individuals and non-Hispanic individuals were more likely to be taking antithrombotic agents.

Overall, the authors concluded that while the level of use of antithrombotic agents appeared high, further research should investigate whether the remaining 20 percent of stroke survivors had indications for antithrombotic therapy that outweighed any contraindications, and, if so, why they were not taking these medications -- particularly younger, female and Hispanic patients.
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Additional authors included Dr. Stanley N. Cohen, Martin L. Lee, Stefanie D. Vassar and Dr. Alex Y. Chen. The study was funded by the NIH/National Institute of Neurological Disorders and Stroke, the National Center on Minority Health and Health Disparities, and the American Heart Association.

The authors have no financial ties to disclose.

The UCLA Health Services Research Program in Neurology aims to create a scientific basis for improving the care received by people with chronic neurological conditions and to better measure the effects of this care. It is one of only a handful of programs worldwide dedicated to this mission. The program involves physician-scientists, clinicians, social and behavioral scientists, a health economist, and a biostatistician. Their research encompasses a wide range of neurological conditions including, but not limited to, stroke, Alzheimer's disease, Parkinson's disease, epilepsy and multiple sclerosis.

University of California - Los Angeles

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