NEW ORLEANS -- A snapshot of the current use of aspirin, warfarin and other stroke prevention therapies at academic medical centers has developed into a less than perfect picture, according to a new study.
Researchers announced their results here today at the American Stroke Association's 25th International Stroke Conference. The American Stroke Association is a division of the American Heart Association.
As part of the University Health System Consortium Ischemic Stroke Benchmarking Project, researchers found that in a group of patients who had a prior stroke and were admitted to the hospital with another stroke, 40 percent were not on prevention therapy such as aspirin, warfarin or other clot-preventing medications.
The study investigators have not yet determined whether the problem lies more with hospital staff not prescribing medications or patients not taking them.
"There is some question as to whether it's one or the other, but regardless, the current situation rates a failing grade," says the study's lead author, Judith H. Lichtman, Ph.D., associate research scientist, department of neurology and Center for Outcomes Research and Evaluation at Yale University, New Haven, Conn.
"To find these results even among those at highest risk of stroke -- those who have already had a prior stroke -- is disappointing," she adds. "This shows how important it is to change physician behavior and the importance of compliance -- both by patients and physicians -- in reducing the risk of stroke." The study of 961 patients with ischemic stroke -- the type of stroke caused by clots blocking blood flow to the brain -- is part of ongoing research being conducted in 36 academic medical centers across the country. The benchmarking project was launched in January 1996. The names of the participating medical centers are kept confidential to preserve the integrity of the research, says Lichtman.
"This comprises almost 1,000 patients at the best hospitals and academic environments," says Lichtman. "If this is the case in those leading institutions, then the general community hospital rates are probably even lower."
Researchers found that of the patients studied, just over a third (34 percent) had a prior stroke or mini-stroke, also called a transient ischemic attack (TIA). The risk of another stroke is much higher for those who have already had one. People who have had a TIA, for example, are 9.5 times more likely to have a stroke than people who have not had a TIA. In the group of patients who had a prior stroke or TIA, 38.4 percent were not on a clot-inhibiting (antithrombotic) therapy. Aspirin and other clot-inhibitors such as warfarin, ticlopidine and dipyridamole have been shown to be useful in helping prevent a second stroke. Researchers found that 41.2 percent of those who had a prior stroke or TIA were on an aspirin therapy; 6.8 percent were on ticlopidine; 2.5 percent were receiving dipyridamole; 15.5 percent were on warfarin; and 1.9 percent were on heparin therapy.
"Seeing that only about 60 percent of the people at the highest risk for stroke are getting the treatment to prevent another stroke is distressing to me," says Lichtman.
In addition, a large number of people who had stroke risk factors such as a prior heart attack or chest pain, a kind of abnormal heart rhythm called atrial fibrillation or advanced vessel disease, were not receiving appropriate treatment. About 40 percent of those falling into this category were not receiving antithrombotic therapy. Some groups, however, had higher rates of antithrombotic therapy those over 65, Caucasians and those with at least one major form of heart disease.
"I was really surprised at the large number of people who weren't coming in the door on one of these therapies despite the fact that they had at least one major stroke risk factor," says Lichtman. "People need to be their own health advocates. Hopefully research like this prompts individual patients to request more options for therapy."
The study was split evenly between men (52 percent) and women. Most of those studied (60 percent) were 65 years and older.
Co-authors are Harlan M. Krumholz, M.D.; Julie Cerese, R.N.; and Lawrence M. Brass, M.D.