Preventing Repeat Strokes – Are Survivors Taking Their Medicine?

Overall use of blood-thinning agents not improving despite more options

San Diego, CA, 1 December 2009 – Since 1999, stroke survivors have been advised to use aspirin, prescription antiplatelet agents, or prescription anticoagulants to help avoid another stroke. Many large surveys of the U.S. population have reported the use of aspirin for secondary prevention, but commonly combine people with stroke and coronary artery disease, and only rarely report the use of antithrombotic agents other than aspirin. In an article published in the January 2010 issue of the American Journal of Preventive Medicine, researchers analyze survey data over a 7-year period to determine whether true usage of all preventive therapies, including aspirin, is increasing.

The annual Medical Expenditure Panel Survey (MEPS) contains data on use of both aspirin and prescription medications. Each year, a MEPS panel is drawn from respondents from the previous year’s National Health Interview Survey, a representative sample of the U.S. civilian non-institutionalized population with oversampling of minority populations and households with low family income.

In the seven annual MEPS data sets from 2000–2006, there were 4168 people who reported a cerebrovascular event. Pooling results across the 7 years, 57% were taking aspirin, 66% were using any antiplatelet agent, and 75% were using any antithrombotic agent. After excluding people who said that they were not taking aspirin because it was unsafe, 81% were using any antithrombotic agent.

Lead author Eric M. Cheng, MD, MS, and co-authors state, “Even though use of prescription antiplatelet medications is rising, aspirin remains the predominant antithrombotic agent used for secondary stroke prevention. There were no improvements in overall use of antithrombotic agents over the 7-year period. Use of aspirin, prescription antiplatelet agents, and use of any antiplatelet agent increased over the study period, but after dropping the first 2 years, no temporal trend was detected, indicating that temporal changes in usage of these agents had plateaued.”

The authors also found that older non-Hispanic men were more likely to be taking antithrombotic agents. They conclude “Although the level of use of antithrombotic agents appears high, further research should investigate whether the remaining 20% truly have indications for antithrombotic therapy that outweigh any contraindications, and, if so, why they are not taking these medications, particularly among younger, female, and Hispanic patients.

The article is “Use of Antithrombotic Agents Among U.S. Stroke Survivors, 2000–2006” by Eric M. Cheng, MD, MS, Stanley N. Cohen, MD, Martin L. Lee, PhD, Stefanie D. Vassar, MS, and Alex Y. Chen, MD, MS. The article appears in the American Journal of Preventive Medicine, Volume 38, Issue 1 (January 2010) published by Elsevier.

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Notes for Editors:
Full text of the article is available upon request; contact eAJPM@ucsd.edu to obtain copies. To schedule an interview with lead author Dr. Eric, M. Cheng, please contact Amy Albin, Sr. Media Relations Representative, UCLA Health Sciences Media Relations, voice: 310-794-8672 or 310-794-0777; aalbin@mednet.ucla.edu.

Authors are:
Eric M. Cheng, MD, MS, University of California, Los Angeles/VA Los Angeles
Stanley N. Cohen, MD, Nevada Neurosciences Institute, Las Vegas
Martin L. Lee, PhD, University of California, Los Angeles/VA Los Angeles
Stefanie D. Vassar, MS, University of California, Los Angeles/VA Los Angeles
Alex Y. Chen, MD, MS, University of Southern California, Los Angeles

About The American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

The American Journal of Preventive Medicine is ranked 12th out of 105 Public, Environmental & Occupational Health titles and 16th out of 107 General and Internal Medicine titles according to the 2008 Journal Citation Reports© published by Thomson Reuters.

About Elsevier

Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Elsevier Research Intelligence,and ClinicalKey—and publishes over 2,200 journals, including The Lancet and Cell, and over 25,000 book titles, including a number of iconic reference works.

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