Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Aug;74(8):1100–1104. doi: 10.1136/jnnp.74.8.1100

Antithrombotic drugs in secondary stroke prevention among a community dwelling older population

F Landi 1, M Cesari 1, G Onder 1, V Zamboni 1, F Lattanzio 1, A Russo 1, C Barillaro 1, R Bernabei 1
PMCID: PMC1738627  PMID: 12876242

Abstract

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.

Design: 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.

Full Text

The Full Text of this article is available as a PDF (149.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Diener H. C., Cunha L., Forbes C., Sivenius J., Smets P., Lowenthal A. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996 Nov;143(1-2):1–13. doi: 10.1016/s0022-510x(96)00308-5. [DOI] [PubMed] [Google Scholar]
  2. Dippel D. W. The results of CAPRIE, IST and CAST. Clopidogrel vs. Aspirin in Patients at Risk of Ischaemic Events. International Stroke Trial. Chinese Acute Stroke Trial. Thromb Res. 1998 Sep 15;92(1 Suppl 1):S13–S16. doi: 10.1016/s0049-3848(98)00102-9. [DOI] [PubMed] [Google Scholar]
  3. Forbes C. D. Secondary stroke prevention with low-dose aspirin, sustained release dipyridamole alone and in combination. ESPS Investigators. European Stroke Prevention Study. Thromb Res. 1998 Sep 15;92(1 Suppl 1):S1–S6. doi: 10.1016/s0049-3848(98)00099-1. [DOI] [PubMed] [Google Scholar]
  4. Gage B. F., Fihn S. D., White R. H. Warfarin therapy for an octogenarian who has atrial fibrillation. Ann Intern Med. 2001 Mar 20;134(6):465–474. doi: 10.7326/0003-4819-134-6-200103200-00011. [DOI] [PubMed] [Google Scholar]
  5. Gaspoz Jean-Michel, Coxson Pamela G., Goldman Paula A., Williams Lawrence W., Kuntz Karen M., Hunink M. G. Myriam, Goldman Lee. Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. N Engl J Med. 2002 Jun 6;346(23):1800–1806. doi: 10.1056/NEJM200206063462309. [DOI] [PubMed] [Google Scholar]
  6. Gent M., Blakely J. A., Easton J. D., Ellis D. J., Hachinski V. C., Harbison J. W., Panak E., Roberts R. S., Sicurella J., Turpie A. G. The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Lancet. 1989 Jun 3;1(8649):1215–1220. doi: 10.1016/s0140-6736(89)92327-1. [DOI] [PubMed] [Google Scholar]
  7. Hartmaier S. L., Sloane P. D., Guess H. A., Koch G. G., Mitchell C. M., Phillips C. D. Validation of the Minimum Data Set Cognitive Performance Scale: agreement with the Mini-Mental State Examination. J Gerontol A Biol Sci Med Sci. 1995 Mar;50(2):M128–M133. doi: 10.1093/gerona/50a.2.m128. [DOI] [PubMed] [Google Scholar]
  8. Hawes C., Morris J. N., Phillips C. D., Mor V., Fries B. E., Nonemaker S. Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS). Gerontologist. 1995 Apr;35(2):172–178. doi: 10.1093/geront/35.2.172. [DOI] [PubMed] [Google Scholar]
  9. Kutner M., Nixon G., Silverstone F. Physicians' attitudes toward oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation. Arch Intern Med. 1991 Oct;151(10):1950–1953. [PubMed] [Google Scholar]
  10. Landi F., Gambassi G., Lapane K. L., Sgadari A., Gifford D., Mor V., Bernabei R. Comorbidity and drug use in cognitively impaired elderly living in long-term care. Dement Geriatr Cogn Disord. 1998 Nov-Dec;9(6):347–356. doi: 10.1159/000017087. [DOI] [PubMed] [Google Scholar]
  11. Landi F., Lattanzio F., Gambassi G., Zuccalà G., Sgadari A., Panfilo M., Ruffilli M. P., Bernabei R. A model for integrated home care of frail older patients: the Silver Network project. SILVERNET-HC Study Group. Aging (Milano) 1999 Aug;11(4):262–272. doi: 10.1007/BF03339667. [DOI] [PubMed] [Google Scholar]
  12. Landi F., Lattanzio F., Gambassi G., Zuccalà G., Sgadari A., Panfilo M., Ruffilli M. P., Bernabei R. A model for integrated home care of frail older patients: the Silver Network project. SILVERNET-HC Study Group. Aging (Milano) 1999 Aug;11(4):262–272. doi: 10.1007/BF03339667. [DOI] [PubMed] [Google Scholar]
  13. Landi F., Onder G., Cesari M., Gambassi G., Steel K., Russo A., Lattanzio F., Bernabei R. Pain management in frail, community-living elderly patients. Arch Intern Med. 2001 Dec 10;161(22):2721–2724. doi: 10.1001/archinte.161.22.2721. [DOI] [PubMed] [Google Scholar]
  14. Landi F., Tua E., Onder G., Carrara B., Sgadari A., Rinaldi C., Gambassi G., Lattanzio F., Bernabei R., SILVERNET-HC Study Group of Bergamo Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care. 2000 Dec;38(12):1184–1190. doi: 10.1097/00005650-200012000-00005. [DOI] [PubMed] [Google Scholar]
  15. Monette J., Gurwitz J. H., Rochon P. A., Avorn J. Physician attitudes concerning warfarin for stroke prevention in atrial fibrillation: results of a survey of long-term care practitioners. J Am Geriatr Soc. 1997 Sep;45(9):1060–1065. doi: 10.1111/j.1532-5415.1997.tb05967.x. [DOI] [PubMed] [Google Scholar]
  16. Moroney J. T., Tseng C. L., Paik M. C., Mohr J. P., Desmond D. W. Treatment for the secondary prevention of stroke in older patients: the influence of dementia status. J Am Geriatr Soc. 1999 Jul;47(7):824–829. doi: 10.1111/j.1532-5415.1999.tb03839.x. [DOI] [PubMed] [Google Scholar]
  17. Morris J. N., Fries B. E., Steel K., Ikegami N., Bernabei R., Carpenter G. I., Gilgen R., Hirdes J. P., Topinková E. Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997 Aug;45(8):1017–1024. doi: 10.1111/j.1532-5415.1997.tb02975.x. [DOI] [PubMed] [Google Scholar]
  18. Petty G. W., Brown R. D., Jr, Whisnant J. P., Sicks J. D., O'Fallon W. M., Wiebers D. O. Frequency of major complications of aspirin, warfarin, and intravenous heparin for secondary stroke prevention. A population-based study. Ann Intern Med. 1999 Jan 5;130(1):14–22. doi: 10.7326/0003-4819-130-1-199901050-00004. [DOI] [PubMed] [Google Scholar]
  19. Quilliam B. J., Lapane K. L. Clinical correlates and drug treatment of residents with stroke in long-term care. Stroke. 2001 Jun;32(6):1385–1393. doi: 10.1161/01.str.32.6.1385. [DOI] [PubMed] [Google Scholar]
  20. Rockwood K., Ebly E., Hachinski V., Hogan D. Presence and treatment of vascular risk factors in patients with vascular cognitive impairment. Arch Neurol. 1997 Jan;54(1):33–39. doi: 10.1001/archneur.1997.00550130019010. [DOI] [PubMed] [Google Scholar]
  21. Wolf P. A., Clagett G. P., Easton J. D., Goldstein L. B., Gorelick P. B., Kelly-Hayes M., Sacco R. L., Whisnant J. P. Preventing ischemic stroke in patients with prior stroke and transient ischemic attack : a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. 1999 Sep;30(9):1991–1994. doi: 10.1161/01.str.30.9.1991. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES