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ChineseMedicalJournal2009;122(2):165—168165OriginalarticleTheutilizationstatusofaspirinforischemicstrokethesecondarypreventionofKEXian-jun,YUYong—fei,GUOZhen—li,XUKang,HAlHong,ZHANGAi—he,JIANGHongandPENGHongKeywords:ischemicstroke;aspirin;secondarypreventionBackgroundThepresentstudywasaimedtoinvestigatetheusageofaspinnforthesecondawpreventionofischemicstroke.
evaluatethecorreIatedfactors.
andanalyzethereasonsfornottakingandirregularlytakingaspirin.
MethodsThepatientsinthisgroupwerealIstrokesurvivorswhohaveformerlybeendiagnosedwithacerebraIinfarctionortransientischemicattack(TIA)inourhospital.
Weinvestigatedtheiruseofaspinnoverathroe·yearperiodfoIlowingtheirhospitalization.
Accordingtothepatients'aspirinusage.
theyweredividedintotreatmentandnon-treatmentgroups.
Inaddition,thereasonsfornottakingorirregularlytakingaspirinwereanalyzedinthetwogroups.
ResultsAtotalof1240patientswerestudied,including367(29.
60%)inthetreatmentgroupand873(70.
40%)casesinthenon·treatmentgroup.
Inaddition,201(16.
20%)casesinthetreatmentgrouphadbeenregularlytakingaspirin(50-325mgofaspirindaily)for1103yearsorIonger.
Theresultsdemonstratedthatthemainreasonsfornottakingaspirininthisstudywere伦latedtopatients'concemsregardingthesideeffectsoftakingaspirin(46.
45%),aswelIasthedoctors'inadequacyininformingtheirpatientstotakeaspirin(38.
71%).
Themajorreasonsforpatientstoirregularlytakeaspirinwerethatthedoctorsdidnotnotifythelengthofaspirinusagetotheirpatients(41.
57%),andthatdoctorsdidnotprescribeaspinnuponthepatients'follow-upvisit(26.
51%).
ConclusionThemosteffectivewaytoincreasepatient'scomplianceforaspirinconsumptionistopromotetheguidelinesforstroketreatmentandtorelaytheseadvancesinstroketherapytothepatient.
ChinMedJ2009;122f21:165-168入Tumerousstudieshavedemonstratedthee伍cacyof上、aspirininpreventingtherecurrenceofischemicstroke.
BotlltheAmericanHeartAssociationandAmericanStrokeAssociationCouncilonStroke(AHA/ASA).
aswellastheChineseMedicalAssociation7sNeuropathyBranchforCerebrovascularDiseaseStudyGroup,recommendthatpatientswithischemicstrokeshouldregularlytakeaspirin.
"'However,wefoundthattheusagerateofaspirinwasfarlessthantherecommendedrequirementssuggestedbytreatmentguidelinesandclinicalpractitioners.
ThepurposeofthisstudywastoinvestigatetheusageofaspirinforsecondarypreventivetreatmentamongthesurvivorsofiSchemicstroke.
Afterhospitaldischarge,severalcorrelativefactorswereevaluatedandparticularattentionwasfocusedonanalyzingthereasonsfornottakingandirregularlytal(1ngaspmnamongstrokepatients.
M【ETHoDSStudysubjectsPatientswerepreviouslydiagnosedwithcerebralinfractionortransientischemicattack(TL~)inourhospitalwitlladiseasehistoryrangingbetween2weeksto5years.
Thediagnosiswasbasedonthepatient'smedicalhistory.
physicalandneurologicalexaminationdata.
andthebrainCTorMⅪscanresults.
Informedconsentwasobtainedfromeachpatientandthisstudywasapprovedbvtheinstitution'shumanresearchcommittee.
MethodsThestudywasaretrospectiveinvestigationofrecentstrokepatients.
ThecustomerservicedepartmentofourhospitalperformedphoneinterviewswiththeischemicstrokepatientswhowerepreviouslydischargedfromourNeurologyDepartmentbetweenOctober2002andOctober2006.
nlepatientswereclassifiedintotwogroups.
treatmentandnon—treatment,accordingtotheircomplianceofaspirinconsumption.
Thereasonsfornottakingaspirininthenon—treatmentgroupandirregularlytakingaspirininthetreatmentgroup(regularlyuseofaspirindefinedastakingaspirinatdosesof50_325mg/dforlto3yearsorlonger)wereinvestigated.
Inaddition,wealsoexaminedthedosagesofaspirinusedinthetreatmentgroup.
Thewholesurveyincludedpatients'gendenage,takingaspirinornot,dosageofaspirinused,andreasonsfornottakingorirregularlytakingaspirin(notethatthepatientsalsoprovideanswerstoquestionssuchaswhethertheirdoctorsinformedthemtotakeaspirin,theirfinancialsituation,tIleefficacyofaspirin,side-effects,etc).
StatisticalanalysisThestatisticalanalysiswasperformedbydescriptiveDOI:10.
3760/cma.
j.
issn.
0366—6999.
2009.
02.
010DepartmentofNeurology,People'sHospitalofEastandWestLakeDistrict,Wuhan.
Hubei430040,China(KeXJ,YuYF'GuoZL,XuK.
HajH.
ZhangAH,JiangHandPengH)Correspondenceto:Dr.
KEXian-jun,DepartmentofNeurology.
People'sHospitalofEastandWestLakeDistrict.
Wuhan.
Hubei430040.
China(Tel:86·27-832l3l07.
Email:kxj2688@l63.
com)万方数据166ChinMedJ2009;122(2):165一1681塾坠!
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箜里12PatientsnotinformedFinanciallyincompetentConc—e—rnsaboutside-effectsWithcontradictionsTakingineffectivenessHerbalmedicineOthers.
No.
ofcases338394021728819554Table2.
Reasonsforirregularlytakingaspirininthetreatmentgroup(totalof166cases)Pr%eriptionPatientnotinformedFinanciallyIneffectivenessandwi山型i尘型!
:!
垡壁竖Othersdiscontinuedofdeadlineincompetent∞if-discontinuedeontradictio衄GIdiscomfortHemorrhagesNumberofcases4469423227218Table3.
Surveyofaspirinusageint11etreatmentgroupftotalof367cases)!
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塑堡gNo.
ofeases855842166492lPercentage(%)23.
1615.
8011.
4545.
231.
092.
450.
550.
27analysisandfrequencyanalysis.
RESm'SAtotalof1240patients.
consistingof763malesand477females(ratioof1.
6:l、withanaverageageof63.
43±8.
1Iyears.
werephoneinterviewed.
Therewere873casesintIlenon—treatmentgroup(70.
40%)and367casesinthetreatmentgroup(29.
60%).
Inthetreatmentgroup,201patients(16.
20%)tookaspirinregularlyand166patients(13.
40%)tookitirregularlyformultipleI.
eaSOnS.
Furthermore.
inthenon.
treatmentgroup,338patients(38.
7l%)mentionedthattheirdoctorsdidnotnotifythemtotakeaspirin.
39patients(4.
47%)werefinanciallyincapableoftakingaspirin.
402patients(46.
45%1wereconcernedwithside.
effects,and17patients(1.
95%)hadcontradictiontoaspirinsuchasallergicreactions,pepticulcers,andbleedingdisorders,etc.
Inaddition,288patients(32.
99%)questionedtheefficacyofaspirin,and195patients(22.
34%)optedtotakeChineseherbalmedicines(suchasSaiviaeMiltiorrhizaeandLigusticumchuanxiongHortwhichpromotebloodcirculation).
Therestofthe54patients(6.
19%)didnottakeaspirinforvariousotherreasons.
Therefore,thisstudydemonstratedthatthemajorcausescontributingtothelowaspirinusageratesweretheconcernsofside—effectsandthedoctors'inadequacyininformingpatients.
Interestingly,t11isstudyalsodemonstrated山atahighpercentageofpatientstookChineseherbalmedicines(Table1).
Inthetreatmentgroup,180patients(89.
55%)wereencouragedtotakeaspirinbythemedicalstaff,whereas21patients(10.
45%)wereadvisedbynon—medicalstaff(includednon—selfandselfadministration).
Wrealsosurveyedthereasonsforirregularlytakingaspirininthetreatmentgroup.
Theresultsindicatedthattherewereseveralreasonscontributingtothestoppingofaspirinconsumptionbythepatients.
Thetwomostcommonreasonswerethatthedoctorsdidnotaddressthedurationoftakingthedrug(41.
57%)orthedoctorsdidnotprescribethedrugduringthefollow—upvisits(26.
5l%).
Moreover,l8.
67%ofthepatientsstoppedtakingaspirinasaresultofthecontradictionsandside—effects.
Also.
13.
86%ofthepatientsthoughtthebenefitsoftakingaspirinwereminimal.
while2.
4l%ofthepatientshadfinancialdifficulties.
Therestofthe10.
84%patientsstoppedbecauseofotherreasons(suchasconcernswiththeside—effectscausedbylong··termusage).
switchedtoaChinesemedicine.
orlistenedtotheirdoctors'recommendations(Table2).
ThesurveysexaminingthedosageofaspirinusedinthetreatmentgroupsarelistedinTable3.
Theresultsdemonstratethatmostcommondoseusedbythepatientswas100mg/d(45.
23%),thesecondmostcommonwas25mg/d(23.
16%),andtheleastfrequentdosagewas_>300mg/d(0.
27%).
DISCUSSIONTherecurrenceofischemicstrokeisexceptionallycommon.
Thisrecurrencewilloftenexacerbatethepatients7ongoingneurologicaldisordersandsignificantlyincreasetheirmortality.
BasedonthestudiesofTIAandmildischemicstrokepatients,ithasbeenshownthattheriskofstrokerecurrenceis10%duringthefirstweekand18%overthenext3months.
Additionally.
theriskwas3timeshigherinthosepatientswhohadischemicstrokescausedbylargevesselvasculopathy,andwas5timeslowerwhencausedbysmallvesselvasculopathy.
Lastly,othervascularconditionsmightalsohaveeffectsontherateofrecurrences.
3111us:itisveryimportanttoadministeratreatmentasasecondarypreventionafterthefirststrokeoccurrence.
Aspirinisthemostcommonandwidelyusedanticoagulantandisconsideredalleffectivedruginthesecondarypreventionofischemicstrokeworldwide.
InChina,onlyafewstudieshavereportedtheuseofaspirinforthesecondarypreventionofischemicstroke,andonlyonepreviousreporthasfocusedonanalyzingthereasonsaccountingfortherelativelylowaspirinusagerates.
'Inourstudy,29.
60%ofischemicstrokesurvivorsreceivedaspirintIlerapy,and16.
20%wereregularlytakingaspirin.
ThisratewasveryclosetotherateobservedinanItaliangroup'sstudy(30%),3butmuchlowerthantheChinesestudybvWUetal(73.
1%).
.
万方数据chi眦seMedicntJoumm2009:122{2):i65一168167However.
ourstIldyonlytookaspirinintoconside瑚【tion,whilet11estIldvbVWuetaloexamilledotller孤ticoaglllarItsaswell.
ourstudVp—ma^lyin、忙stigated锄d锄alyzedthereasonsfornottakin2orirregularlytabngaspirin.
TheseresultsindicatedthattlleprinciplereasonfornottaJ(ingaspirinw勰matthepatientswereconc啪edaboutmeside.
ef!
fects(46.
45%).
Thepercentageofpatientswhowerenottal(ing0rwhostoppedLal(ing懿pirinduetocon仃adictions(inc】udingallergicreactionstoaspirin,pepticulcers,柚dbleedingdisorders,etc.
)were1.
95%a11d1.
2%,respectively.
IIladdition,therewere17.
47%ofpatientswhostoppedtakingaspirinafberexperiencingaccompanyingside—eff色cts.
Amongtheseindividuals,a胁ctionof山epatientsdidnotseekⅡeatIIlentfort11eirside.
ef!
Fectsandstoppedtal(ingaspirinupontlleirownvolition.
Dudngttlecour∞ofthisstudy'meau山orsobservedthat眦lypatientshads仃ongpreiudicesagainstaspi—nalldmoughtitwasprimarilyusedfor仃eatingdleumatoidarthntis(RA).
Moreover'merewas鲥soaponionofpatientswhoconsideredtllatmeydidnotbenefitnDmta虹n2asp证n,sot11eVeimerdidnottakeorstoppedtaldngaspirin(32.
99%andl3.
86%,r.
espectiVely).
Therefore,educatingpatientsregardingaspirinusageisnoton】yessentialbutextremelyurgent.
Nota.
bly,38.
7l%ofpatientsdidnottakeaspirinbecausemeywerenotclearlyrecommendedtodosobyt11eirdoctorsupondischarge仃Dmthehospital.
IIladdition,sorrlepatientsdiscontinuedtal(ingaspirinbecausetheywereeithernotinfomedofmedurationfortabngt11ednlgorwerenotgivenmeprescriptionf幻mthedoctordu—ngttleirfollow.
upvisits(41.
57%and26.
5l%,respectively).
Theseweretllemainre舔onsforpatientstoi丌Iogularlyta:keaspirin.
Furnlemlore,ttlisstudvalsorevealedthatsomedoctorswereunawareofmebenefitsofaspirinusefortllesecondarypreventionofs仃')ke;卸dmerefore,lackedmeabili"toeducatepatients.
However'山esefindingsmjghtalsoberelatedtotllehistoricallackofstandards仃okepreventionguidelinesiIlChina.
F()咖natelV.
the"ChineseCerebrovascularDiseasef'reventionandT}eannentGuidelines"aredbout乜obepublished,蛐ditwillbeexn.
emelycriticaltoemphasizet11eunderstarIdingoftheseguidelines锄dpromotetheirutilizationintllefuture.
Interestingly,ahighpercentageofttleDatientsinmisstudycOnsumedChinesehe巾almedicines,indicatingmatt11esepatientspreferentiallyusedherbalmedicines.
Unforcunatelv,thereisa1ackofscientificevidenceaddressingwhetherherbalmedicinesareef!
f.
ectiveformesecondaD,preVentionofischernics廿oke.
Thus.
weproposethatitisessentialtohavemulti—centeranddouble_blindedclillicalsmdiesexa嘶ningChineseherbalmedicinesforme∞condaDrpreVentionofischeIIlics讶oke.
IIl"sstudy,wealsosun,eyedmedosagesofaspirinadIIliniste剃anddemons仃atedt11at73.
56%ofpatientstookbeMeen5肚l50Ⅱ唱朋,withthemajorityofpatients(45.
23%)consuIniIlg100mg/d.
HoweVer,23.
16%ofpatientsused25mg/d.
Somesmdieshaveshownmatdosages舢gingf哟m50—1300mg/dwerememostef.
fectiveinmeDreventionofischeITIicstTDkeeimerbefore0raRerTIA.
"'IIlterestingly'咐orandomizedcon"01ledtrialscomparingdifI'erentdosages(1200mg/dto300mg/d,and283mg/dto80mg/d)usedinischemics仃oke锄dTIApatientsⅢ一1showedthattheef俺ctsonVasculardiseasepreVentionweresirnjlarinmemgh锄dlowdosegroups.
However'thehigherdosestendedtohaveahigherriskofgastrointestinalbleeding.
'厶1'TheAHA_,ASAreconunendedaspirindoseis50—325mg/d,1wh订emeChinaCerebrovascularDiseasePreventionandTreamlentGuideliIlessuggestsadoseof50_l50mg/d.
'hsummary'Ⅱleratesofusingaspirinformesccondarypreventionofischemics仃okeandtlledosagesutilizedwerelow帅ongChinesestrokepatients.
haddition,thereweresevemlfactorsassociatedwitllmesefindings.
However'ttlemostimportantoutcomeistopromoteaIldpublicizetheclinical霉midelinesandtoeducatettlepatientabouttheseadvancementsi11scienceandtcchllolo跚Accordingly'山eseareparticularlyimportantresponsibilitiesformemedicalstaff姐dphysici肌shlthefieldofneurology.
REFERENCES1.
SaccoRL.
AdarIIsR.
Albe巧GAlh帆sMJ,BenaventeO,Furiel乞eta1.
Guidelinesfbrpreventionofs订okeinpati即tswi血ischeTrIics仃okeor仃ansientischeIIlic撇k:AstatementfbrheaItllcarepmfessionalsf而m山eAI眦ricanHeartAssociatioIl,Am嘶canSⅡol【eAssociati伽CouncilonS仃okec0一sponsoredby血ecounciloncardiov豳cul越radiology柚dintervention.
S汀oke2006:37:577—617.
2.
Rao~IL.
Chinace陀brovasculardiseaseprevention锄d呦tmentguidelines.
JApoplexyNervDis2005;22:484_487.
3.
HankeyGJ.
Secon如preventionofrecun.
ent蛐roke.
SⅡokc2005:36:218.
221.
4.
Y扑gJ,HeJS,YangXY.
Investigatetheutilizati伽ofaspi血iIIcardiacoutpati即ts.
CllinJMedGuide(Cllin)2005;7:116_118.
5.
L锄diF'Ces捌M,OnderGzamboniV'Lan柚zioF'Ru骆oA.
cta1.
』‰tit|】∞mb06cdnlgsinsecOndarys仃oI(eprevention砌ongaco衄unitydwelli|lgo】derpopuIa￡ion.
JNeur0】NeurosIlrgPsVchia竹2003:74:1100.
1104.
6.
、^hD,、)17柚gYL,MaRH,BaoH,WangCX,W卸gYJ.
'nIecr}oss.
sectionalstIIdyonu∞of锄ti山mmb甜cd11lgsinsecondarypreventionofischerIlics廿oke.
ChinJG耐a口HeartBrajnVesSelDis(Chjn)2006:8:325.
328.
7.
CanadianCooperativeStudyGroup.
Amdo邛dzedtrialofaspirinandsulfinpyr配oneiIltIII蚀teneds缸Dke.
NEnglJMcd1978:299:53.
59.
8.
DienerHC,CuIIllaL,Fb^)esC,SiveniusJ,SmetsELow印tIlalA.
EuropeanS廿okeP他ventionStIldv.
2:山pVrid锄ole锄dacetylsalicylicacidintlle联圮ondarypfeventionofsn.
okc.
JN跚mlScil996:143:1.
13.
9.
AntiplateletTrialists'Collabom60n.
Collaborativeoverviewof啪doIllisedtrialsof锄tiplateletttlerapy'I:preVentionofdea啦myocarmalinf疵tion,aIldsⅡDkebyprolonged万方数据antiplatelettherapyinvariouscategoriesofpatients.
BMJ1994;308:81.
106.
10.
DumhTIAStudyGroup.
TheDutchr兀Atrial:protectiveeffectsoflOW.
doseaspirinandatenololinpatientswithtransientischemicattacksOrnondisablingstroke.
Stroke1988;19:512.
517.
11.
FarreilB,GodwinJ.
RichardsS,WarlowC.
11IeUnitedKingdomTransientIschaemicARack(UK—TIA)aspirintrial:finalresults.
JNeurolNeurosurgPsych1991,54:1044-1054.
12.
HanssonL.
ZanchettiA,C删tIIersSGDahl6fB,ElmfeidtD,JuliusS.
Effectsofintensiveblood·pressureloweringandlow-doseaspirininpatientswithhypertension:pfi喊叫resultsoftheHypertensionOpumaJTreatment(HOT)randomisedtrial:HOTStudyGroup.
Lancet1998:351:1755一1762.
13.
AnfithromboticTrialists'Collaboration.
Collaborativemeta.
analysisofrandomisedtrialsofantiplatelet山er叩yfbrpreventionofdeath,myocardialinfarction,andstrokeinhighriskpatients.
BMJ2002:324:7l一86.
(ReceivedSeptember10,2008)EditedbyWANGDe万方数据