Antithrombotic management after an ischemic stroke in French primary care practice: results from three pooled cross-sectional studies.
OBJECTIVE
We aimed at quantifying and explaining the underuse of antithrombotic treatments after an ischemic stroke in patients seen in French primary care.


METHODS
We pooled all ischemic stroke patients included in 3 observational primary care-based observational studies. French general practitioners and cardiologists recruited 14,544 patients with atherothrombotic disease including 4,322 with an ischemic stroke. Antithrombotic therapies and risk factors were prospectively recorded. Patients with atrial fibrillation (AF) were considered appropriate for oral anticoagulants (OAC) and those without AF for antiplatelet drugs.


RESULTS
Out of the 4,322 stroke patients, 3,732 (86.3%) were taking at least one antithrombotic drug. Among the 765 patients with AF, 333 (43.5%) received OAC and 2,718 (86.9%) out of the 3,129 patients appropriate for antiplatelet drug were taking antiplatelet drug. Multivariate analyses did not single out any risk factors for nonuse of OAC and showed that female sex (OR = 1.48; IC 95%: 1.14-1.92) was associated with nonuse of antiplatelet drugs. Conversely, past myocardial infarction (OR = 0.44; IC 95%: 0.26-0.71) and hypercholesterolemia (OR = 0.64; IC 95%: 0.50-0.81) were associated with appropriate use of antiplatelet drugs.


CONCLUSIONS
More than 50% of stroke patients with AF do not receive OAC and 15% of those without AF do not receive antiplatelet drugs. These findings are not satisfactorily explained by the main patients' characteristics and practitioner's speciality and underline the complexity of the process which allows the transfer of scientific evidence in clinical practice.
Department of Neurology, Hôpital Sainte-Anne, René Descartes, Paris, France. e.touze@ch-sainte-anne.fr
Emmanuel
E
Touzé
Jean-Pierre
JP
Cambou
Jean
J
Ferrières
Alec
A
Vahanian
Gérard
G
Coppé
Alain
A
Leizorovicz
Gérard
G
Jullien
Martine
M
Guérillot
Marie-Annick
MA
Herrmann
Jean-Louis
JL
Mas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D002545:Brain Ischemia / Q000188:drug therapy; D003430:Cross-Sectional Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005602:France; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors