缺血性卒中二级预防的药物依从性调查

目的评估缺血性卒中患者抗血栓药物和危险因素用药的依从性、停药和药物变更原因及影响因素。方法通过电话随访获得卒中患者出院后1年时用药等方面的情况。结果2002年10月至2003年4月北京天坛医院神经内科缺血性卒中患者412例,其中374例患者进入调查,其中完成电话随访者296例(79.1%)。患者抗血栓药物的依从性为35.1%;伴有高血压、糖尿病和高血脂患者1年后仍接受治疗者的比例分别为77.9%、80.2%和48.4%。医保或公费(OR2.117,95%CI1.174～3.821)可促进患者对药物的依从,非阿司匹林抗血栓药物(OR0.352,95%CI0.153～0.812)和较低的日常生活能力指数(62.5±13.3)(MannWhitneyU检验,P=0.000)可明显降低卒中患者的药物依从性。结论卒中二级预防中药物依从性差主要表现为停药和剂量减小。支付方式、收入水平、抗血栓药物的种类以及患者的个人生活能力等可影响卒中患者的药物依从性。

A study on drug compliance in secondary prevention of ischemic stroke

OBJECTIVE: The aim of the present study is to determine the rate of compliance with secondary stroke prevention one year after ischemic stroke and to identify the reasons for poor compliance. METHODS: The proportion of patients compliant with prevention of risk factors (hypertension, diabetes, hyperlipidemia) was evaluated through structured telephone interviews. RESULTS: Of the consecutive patients admitted to the neurological department of Tiantan Hospital between Oct. 2002 and Apr. 2003, 374 patients were involved in this investigation and 296 (79.1%) were finally evaluated. In the 296 (79.1%) patients, the rate of antithrombotic drug compliance was 35.1%. Of the patients with hypertension, diabetes, and hyperlipidemia, 77.9%, 80.2%, and 48.4% were still treated for their respective risk factors. Influence factors for drug compliance, such as medical insurance and free medical care (OR 2.117, 95% CI 1.174-3.821) can promote the drug compliance in stroke patients, while the use of antithrombotic drugs other than aspirin (OR 0.352, 95% CI 0.153-0.812) and a lower living ability (62.5 +/- 13.3) (Mann-Whitney-P = 0.000) could decrease the drug compliance. CONCLUSIONS: Long-term compliance with secondary prevention in patients with ischemic stroke is poor in the setting of our study. Poor compliance with antithrombotic therapy such as incorrect discontinuation or change and reduction of dosage was noted. Means of payment, income levels, categories of antithrombotic drugs and personal living ability of patients are associated with compliance. Doctors should attach importance to secondary prevention and provide stroke patients detailed guidelines for the use of preventive drugs.