Résumé
Objective To investigate the application of secondary prevention medication for patients with high risk of recurrent ischemic stroke in Changzhou city,analyze the reasons for decreased medication compliance,and evaluate the current secondary prevention medication.Methods We investigated 300 consecutive hospitalized patients with acute non-cardiogenic and ischemic stroke high risk.High risk of recurrent stroke was defined as ESSEN Stroke Risk Score (ESRS) ≥3.Different ESRS scales consisting of different parameters were analyzed.All of the patients received standard secondary prevention of ischemic stroke at discharge.After three months and a year follow up,antiplatelet therapy,therapy of risk factors (hypertension and diabetes mellitus),lipid lowering therapy,and medication compliance were investigated.Results Except for age (x2 =126.54,P =0.000) and previous cerebral ischemic stroke or transient ischemic attack (TIA) (x2 =21.27,P =0.000),there were no significant differences in other risk factors (hypertension,diabetes,previous myocardial infarction,heart diseases,smoke) in patients with different ESRS scale scores (all P＞ 0.05).Antiplatelet therapy utilization was 98.3％ (295/300),antihypertensive and antidiabetic drug use rates were 95.0％(255/268) and 100％(72/72),statin use rate reached to 99％ (297/300) at discharge.After three months follow up,medication compliance in hypertension and diabetes mellitus therapy was the best [88.1％(222/252)and 86.2％ (56/65)],followed by aspirin [82.0％ (228/278)],and clopidogrel [6.1％ (17/278)].The medication compliance in lipid lowering therapy was the worst [60.1％ (167/278)].After a year follow-up versus the previous three-month follow-up,the medication compliance in hypertension and diabetes mellitus therapy was increased,but had no significant difference [89.9 ％ (220/245) vs.88.1％ (222/252),93.4％(57/61)vs.86.2％(56/65),P＞0.05],and the medication compliances inantiplatelet therapy with aspirin and clopidogrel,and lipid lowering therapy were increased significantly [93.2％ (245/263)vs.82.0％ (228/278),30.8(81/263) vs.6.1％ (17/278),88.9％ (234/263) vs.60.1％ (167/278),all P＜0.01].The increment of use rate was higher in clopidogrel therapy than in aspirin therapy.Conclusions The secondary prevention medication achieves certain efficacies in patients with high risk of recurrent ischemic stroke in changzhou city.Long term follow-up and good communication between doctor and patient can effectively improve the medication compliance in secondary prevention,and can increase the use rate of antiplatelet therapy in patients with high risk of recurrent ischemic stroke.
Résumé
Objective To investigate the effect of plasma fibrinogen (Fib) level on stroke recurrence within one year of first-ever ischemic stroke.Methods The patients with first-ever acute ischemic stroke were enrolled prospectively and were followed up for at least one year.They were divided into either a recurrent group or a non-recurrent group.Multivariate logistic regression analysis was used to explore the risk factors for stroke recurrence within one year of first-ever ischemic stroke.According to the plasma Fib levels of the early onset,the patients were divided into a high Fib group and a normal Fib group.Kaplan-Meier survival analysis was used to compare the recurrence between the two groups.Results A total of 121 patients with first-ever acute ischemic stroke were enrolled,111 completed one year follow up,and 30 of them (27.027％) had recurrent stroke.Multivariatelogistic regression analysis showed that the increased plasma Fib level (odds ratio [OR] 13.238,95％ confidence interval [CI] 1.152-152.077; P=0.038),older at the first onset (OR 1.321,95％ CI1.064-1.641;P=0.012),high body mass index(OR 1.351,95％ CI 1.001-1.823; P=0.049),and poor compliance of antiplatelet drugs (OR 36.819,95％ CI 1.890-717.143; P=0.017) and antihypertensive drugs (OR 50.765,95％ CI 3.198-805.878; P =0.005) were the dependent the risk factors for stroke recurrence within one year of first-ever ischemic stroke.Kaplan-Meier survival function curves showed that the recurrence rate of stroke in the high Fib group was significantly higher than that in the normalFib group (Log-rank test,P =0.000).Conclusions The increased high plasma Fib level,advanced age,obesity,as well as poor compliance of antiplatelet drugs and antihypertensive drugs were the independent risk factors for stroke recurrence within one year of first-ever ischemic stroke.