A Failing Grade in Stroke Prevention
Feb. 11, 2000 (New Orleans) -- People who could most benefit from medications to prevent stroke are not receiving them as frequently as they should, according to a study presented today at the 25th International Stroke Conference.
Overall, almost 60% of the patients were on no medications to help keep the blood from clotting when they arrived at the hospital with symptoms of a stroke, and less than 30% of patients were taking aspirin, which is one of the main drugs used for prevention. More disturbing, almost 40% of patients with a history of stroke or transient ischemic attack (TIA) -- a mini-stroke that can last from a few minutes to 24 hours and is often a sign of worse things to come -- were not receiving any anti-clotting agent, according to Judith Lichtman, PhD, lead author of the study.
"These results showed us a disappointingly low rate of preventive therapy, even among patients at high risk for stroke," Lichtman tells WebMD. "The patients were from academic hospitals, so our feeling is that if we are seeing these kinds of patterns in an academic setting, the situation is probably even more disappointing elsewhere."
"The data really challenge us to understand why there seems to be such a gap between what's actually occurring in clinical practice and what we know should be occurring," adds Lichtman, an associate research scientist at Yale University.
The findings came from patient chart reviews of almost 1,000 people who arrived at 36 teaching hospitals with a stroke brought on by blood clots in the brain. The purpose of the study was to determine how frequently medication to help prevent stroke was being used. Many of these patients were considered at high risk for having a stroke due to already existing conditions such as a prior stroke, TIA, or heart disease.
"We thought that this type of review would give us a pretty good idea of what's going on in clinical practice, in terms of stroke prevention," says Lichtman.
Overall, just under two-thirds of the patients had no record of anti-clotting agents prior to admission. Among patients who were on anti-clotting treatment, aspirin was being taken in only about a third of the patients, and other less common but stronger blood-thinning drugs such as Coumadin (warfarin) were being used by less than 10% of the patients.
A third of the patients had a history of stroke or TIA. In this group, almost 40% of patients had no documented anti-clotting therapy. Medication use revealed in the records consisted of aspirin in just four out of 10 of the patients, and no more than 15% were on any other kind of blood-thinning agent.
The researchers then looked at people with a history of heart attack or angina (chest pain) as well as other conditions that put patients at high risk of having a stroke, such as the heart rhythm problem known as atrial fibrillation and a history of blood vessel disease in the legs. All these conditions are felt to benefit from stroke prevention with blood-thinning drugs. These patients showed a similar pattern of medication use. About 40% were on no anti-clotting therapy prior to their strokes, said Lichtman.