Clinical Study Of Drug Therapies For Secondary Prevention Of Ischemic Stroke

Objective Drug therapies for secondary prevention can prevent the recurrence of stroke,reduce the mortality rate,and decrease the risk of recurrent stroke,which should be paid much attention to.Studies at home and abroad have shown that the compliance of drug therapies for secondary prevention is generally low.To assess the status of the application of drug therapies for secondary prevention and to reduce the recurrence of stroke,the present study was carried out to investigate the status of the compliance of antithrombotic drugs for secondary prevention after ischemic stroke in Qingdao and its effect on the prognosis,and to analyze relevant mechanisms for poor compliance or with drawal of drug therapies for secondary prevention in patients with ischemic stroke,so as to provide the basis for the formulation of corresponding clinical strategies.Methods A total of 501 inpatients with acute cerebral infarction or transient ischemic attack hospitalized in the Affiliated Hospital of Qingdao University Medical College from November 2014 to January 2016 were selected for outpatient and telephone follow-up.The compliance,influencing factors and causes of drug withdrawal were evaluated in patients with the administration of antithrombotic drugs for secondary prevention.The drug compliance was measured by the number of days of taking drugs according to doctor’s advice.Good compliance was defined as the number of days of taking drugs according to doctor’s advice ≥ 80% of the total days of follow-up.The obtained data were analyzed using statistical software SPSS19.0.Results Of the 501 patients investigated in this study,29 cases were lost during the followup period,27 cases died and 15 cases had no antithrombotic drugs in discharge order(9cases of oral or nasal bleeding after taking the medicine,and 6 cases of recent gastrointestinal bleeding).Finally,a total of 430 cases were successfully followed up,among which 277 cases were divided in aspirin group,123 cases in aspirin + plavix group,16 cases in plavix group and 14 cases in anticoagulant drugs group.In the 12 months after discharge,there were 373 patients with good antithrombotic drug compliance,and 53 patients with poor compliance.Our study found that there were significant statistical differences in smoking history(P = 0.013,X2 = 6.124),drinking history(P = 0.000,X2 = 24.992),history of diabetes(P = 0.015,X2 = 5.932),history of stent implantation(P = 0.029,X2 = 4.752),length of hospital stay ≥ 10 days(P = 0.024,X2 = 5.064)between good compliance group and poor compliance group of antithrombotic drugs.Furthermore,by analyzing adverse outcomes of patients with ischemic stroke,there was a statistically significant difference in recurrent cerebrovascular accident between good antithrombotic drugs compliance and poorcompliance groups(P<0.05).Further binary Logistic regression analysis indicated that the good compliance of antithrombotic drugs(P = 0.000,OR = 0.021,95%CI = 0.004-0.130)was an independent protective factor for the recurrence of cerebrovascular diseases in patients with ischemic stroke.After 12 months of follow-up,patients with the administration of plavix and anticoagulant drugs indicated no change in the number of cases compared with that at discharge.However,there was no significant difference between the compliance for the same antithrombotic drug at different follow-up time points in 430 patients(P>0.05).The number of patients with good compliance of antithrombotic drugs in the follow-up period of1 month and 3 months were all 234 cases in aspirin group and 114 cases in double antithrombotic drugs group.Besides,there was statistical difference between the compliance for aspirin and for double antithrombotic drugs after 1 month and 3 months(P=0.020).The compliance rate of patients taking double antithrombotic drugs and aspirin was 92.7%(114/123)and 84.5%(234/277)after 1 month and 3 months of follow-up,respectively,indicating better compliance in the former group than that in the latter group in these two time points.Possible reason for the poor compliance of antithrombotic drugs in 430 patients after discharge was their ignorance of the course of medication(59.95%,51/88).Conclusion The overall compliance is relatively good in ischemic stroke patients with antithrombotic drugs in Qingdao area,especially in patients taking plavix and anticoagulants.The compliance of patients with double antithrombotic drugs are better than that of patients with aspirin after 1 month and 3 months.Influencing factors of antithrombotic drug compliance include smoking history,drinking history,history of diabetes,history of stent implantation and length of hospital stay ≥ 10 days.Meanwhile,good antithrombotic drug compliance is an independent protective factor for cerebrovascular diseases recurrence in patients with ischemic stroke.Reasons for the poor antithrombotic drugs compliance are the ignorance of the course of medication and the failure to meet the requirements of the Guide or discharge order.In clinical medical treatment,it is necessary to take relevant intervention strategies to improve the compliance of antithrombotic drugs and to reduce the risk of recurrence of cerebrovascular diseases.