Antithrombotic drugs in secondary stroke prevention among a community dwelling older population.
BACKGROUND
Patients who suffer a cerebrovascular event are at high risk of a recurrence. Secondary prevention is crucial in reducing the burden of cerebrovascular disease.


OBJECTIVE
To estimate the percentage of stroke survivors receiving antiplatelet or anticoagulant drugs and to identify factors associated with such treatment.


METHODS
Cross sectional retrospective cohort study.


METHODS
Data were analysed from a large collaborative observational study, the Italian "silver network" home care project, which collected data (from 1997 to 2001) on patients admitted to home care programmes (n = 5372). Twenty two home health agencies participated in evaluating the implementation of the minimum dataset for home care (MDS-HC) instrument. For the present study, 648 individuals with a diagnosis of stroke were selected and the initial MDS-HC assessment reported.


RESULTS
70% of stroke survivors did not receive any antiplatelet or anticoagulant drugs (95% confidence interval (CI), 66.5 to 73.5). Among all age categories, aspirin and ticlopidine were the two most commonly prescribed drugs. Living alone (odds ratio (OR), 0.49 (95% CI, 0.24 to 0.89)), dependency in activities of daily living (0.66 (0.40 to 0.99)), cognitive impairment (0.58 (0.38 to 0.86)), and low educational level (0.58 (0.34 to 0.98)) were associated with a reduced likelihood of receiving secondary stroke prevention treatment. Cardiac arrhythmias, coronary artery disease, heart failure, and peripheral vascular disease were associated with the use of antiplatelet or anticoagulant treatment.


CONCLUSIONS
Negative attitudes among physicians with respect to secondary stroke prevention are prevalent and reinforce the need for increased awareness of existing data on the risks and benefits for elderly individuals. Social problems and functional impairment may be issues concerning physicians when deciding whether or not the risks of treatment exceed the benefit.
Landi
F
F
Department of Gerontology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy. francesco_landi@rm.unicatt.it
Cesari
M
M
Onder
G
G
Zamboni
V
V
Lattanzio
F
F
Russo
A
A
Barillaro
C
C
Bernabei
R
R
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D019091:Critical Pathways / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D004185:Disability Evaluation; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006699:Home Care Services; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention
D005343:Fibrinolytic Agents