缺血性卒中二级预防药物依从性研究

()2010241ChinJCerebrovascDis(ElectronicEdition),February2010,Vol4,No.111,152;2004112005121383,,69.1%87.7%,17.1%56.5%,,,;;;AstudyonmedicationinthesecondarypreventionofischemicstrokeWANGLiu2xia,DONGYi,FANGKun,DONGQiang.TheroomofElectrophysiology,Zhong2shanHospitalaffiliatedtoXiamenUniversity,Xiamen,China.DepartmentofNeurolo2gy,HuashanHospitalaffiliatedtoFudanUniversity,Shanghai,ChinaCorrespondingauthor:DONGQiang,E2mail:[e-mail]plorethequalityofsecondarypreventionforis2chemicstrokeprovidedtopatientsbeforeandafterthestartofStrokeUnitinShanghai.MethodsRetrospectiveandprospectivecasenoteanalysis,theretrospectivecohort(beforetheprogram)had152patientswithstrokedischargedduringSep.2003andOct.2004andtheprospectivecohort(aftertheprogram)had138patientswithstrokedischargedduringNov.2004andDec.2005.Dataonuptoconsecutivecases:361004();():,E2mail:[e-mail]12()2010241ChinJCerebrovascDis(ElectronicEdition),February2010,Vol4,No.1submittedbyHuashanhospital.Theanti2thromboticandstatinsmedicationofpatientsandmedicationofriskfactors(hypertension,diabetes,hyperlipidemia)wasevalua2tedthroughstructuredtelephoneinterviews.ResultsAnti2thromboticmedicationandstatinsinthestrokeunitcohortwashigherthanthetraditionalcohort(87.7%versus69.1%,56.5%versus17.1%)atdischarge.Patientswithhypertensionordiabetesweremorelikelytohaveanti2thrombotictreatment3monthsafterdischargeintheprospectivecohort(78.9%versus54.2%,84.6%versus64.7%).ConclusionsStrokeUnitpromotestoimprovemedicationinthesecondarypreventionofischemicstroke,buttherewasstillagapbetweenthepracticeandtheguideline.KeywordsStroke;cardiovasculardisease;Riskfactors;Secondarypreven2tion;Medication,,150/10,120/1030%5,18%[1]Holloway[2]2000,(UCLA)(preventingrecurrenceofthromboemboliceventsthroughcoordinatedtreatment,PROTECT)[3],,,[4]2004,,20039200410,,,152200411200512()2010241ChinJCerebrovascDis(ElectronicEdition),February2010,Vol4,No.113,,,138,[(10,1)(5,250g)];();[ST2T()];;OCSP(oxfordshirecommunitystrokeprojectclassification);TOAST(trialofORG10172inacutestroketreat2ment)()3,,SPEE11.5,,2,1.,,,141(%)60607070/TIA15265.142.825.032.232.914.522.464.514.551.32.613863.842.029.728.334.18.728.365.216.751.38.0P0.8090.6140.8310.1270.2480.8950.6060.8230.0402OCSP(%)1529.939.529.6211386.534.839.918.8P0.3010.4090.0670.63814()2010241ChinJCerebrovascDis(ElectronicEdition),February2010,Vol4,No.13Toast(%)1529.936.841.70.711.213812.331.9421.412.3P0.5060.3750.9200.5060.7644152138P15210569.1%13812187.7%0.001984343.9%905055.6%0.110341544.1%392153.8%0.4071522617.1%1387856.5%0.0015(%)3P3P69.159.90.8787.770.30.8043.972.41.6555.657.81.0444.170.61.6053.856.41.0417.19.90.5656.526.80.476(152)(105)P(138)(97)P22130.27323140.279/TIA28170.28926190.73034250.52439330.02198690.6390710.00222140.551260.20133230.9771980.0205438634565445644()2010241ChinJCerebrovascDis(ElectronicEdition),February2010,Vol4,No.1152.33,,(),3,,,69.1%87.7%,17.1%56.5%,PROTECT,,95%98%;,54%77%[3]2008/(AHA/ASA)[5]2008ESO[6],TIA,,;TIA,(INR2.5;2.03.0)TIA,,NCEP2ATP,,(,A);TIA;(),,(a,B)[7],,,,,,,,3,40.1%29.7%16()2010241ChinJCerebrovascDis(ElectronicEdition),February2010,Vol4,No.1,9.9%26.8%,,,,,,,,3,AHA/ASA2006/[8],,,;TIA,(,A)3,30%40%[9211],,[11],3,,,,,,;,,,,,()2010241ChinJCerebrovascDis(ElectronicEdition),February2010,Vol4,No.1171WilterdinkJL,FurieKL,EastonJD.Cardiacevaluationofstrokepatients.Neurology,1998,51(3):S232S26.2MohlerER,DelantyN,RaderDJ,etal.Statinsandcerebrovasculardisease:plaqueattacktopreventbrainattack.VascMed,1999,4(4):2692272.3OvbiageleB,SaverJL,FredieuA,SuzukiS,McNairN,DandekarA,RaziniaT,KidwellCS.PROTECT2Acoordinatedstroketreatmentprogramtopreventrecurrentthromboembolicevents.Neurology,2004,63:121721222.4OvbiageleB,SaverJL,FredieuA,SuzukiS,SelcoS,RajajeeV,McNairN,RaziniaT,KidwellCS.In2HospitalInitiationofSecondaryStrokePreventionTherapiesYieldsHighRatesofAdherenceatFollow2up.Stroke,2004,35:287922883.5RobertJAdams,GregAlbers,MarkJAlberts,etal.UpdatetotheAHA/ASARecommendationsforthePre2ventionofStrokeinPatientsWithStrokeandTransientIschemicAttack.Stroke,2008,39:164721652.6EuropeanStrokeOrganisation(ESO)ExecutiveCommittee,ESOWritingCommittee.Guidelinesformanage2mentofischaemicstrokeandtransientischaemicattack2008.CerebrovascDis,2008,25(5):4572507.7ScottMGrundy,JamesICleeman,CNoelBaireyMerz,etal.ImplicationsofRecentClinicalTrialsfortheNationalCholesterolEducationProgramAdultTreatmentPanelGuidelines.Circulation,2004,110:2272239.8SaccoRL,AdamsR,AlbersG,etal.Guidelinesforpreventionofstrokeinpatientswithischemicstrokeortransientischemicattack:astatementforhealthcareprofessionalsfromtheAmericanHeartAssociation/Ameri2canStrokeAssociationCouncilonStroke:co2sponsoredbytheCouncilonCardiovascularRadiologyandInter2vention:theAmericanAcademyofNeurologyaffirmsthevalueofthisguideline.Stroke,2006,37(2):5772617.9SappokT,FaulstichA,StuckertE,etal.Compliancewithsecondarypreventionofischemicstroke:apro2spectiveevaluation1.Stroke,2001,32:188421888.10HillenT,DundasR,LawrenceE,etal.Antithromboticandantihypertensivemanagement3m