Timing of aspirin and secondary preventative therapies in acute stroke: support for use of stroke units.
BACKGROUND
We aimed to study the timing of aspirin prescription in ischaemic stroke comparing patients admitted to an acute stroke unit (ASU) directly or via a general medical ward. We also analysed prescription of secondary preventive therapies in stroke patients in an ASU.


METHODS
Retrospective analysis was made of medical notes and prescription records of 69 patients admitted to an ASU over a three month period to establish timing of aspirin prescription with respect to onset of stroke symptoms, CT brain scan and route of admission to the ASU.


RESULTS
CT brain scans were obtained at a median of 2.1 days post stroke (IQ range 1.3-4.3). Patients directly admitted to the ASU received aspirin earlier post admission compared to those admitted via a medical ward (0.7 vs 2.2 days, p < 0.01) and were also more likely to receive aspirin prior to CT scan being performed (57% vs 19%, p = 0.02). 86% of stroke patients were discharged on an antiplatelet therapy, 79% on a statin, 37% on a thiazide diuretic and 32% on an ACE inhibitor or angiotensin II antagonist.


CONCLUSIONS
Aspirin was given more promptly in acute stroke and more commonly prior to CT scanning in an ASU compared to a medical ward. Statin therapy is used extensively in stroke but there is a much lower rate of initiation of other secondary preventive therapies (e.g. anti-hypertensive therapy) in hospital. These findings demonstrate a hesitancy in early use of aspirin amongst general physicians and lends support for the use of stroke units.
Aberdeen Royal Infirmary, Foresterhill, Aberdeen. johnmreid@doctors.org.uk
J
J
Reid
M J
MJ
MacLeod
D
D
Williams
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000517:prevention & control*; D018890:Chemoprevention; D005260:Female; D006753:Hospital Records; D006757:Hospital Units / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000517:prevention & control*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin