Causes of non-effectiveness of secondary prophylaxis of ischemic stroke

Abstract

Aim. To study the aspects of prevention and risk factors of a recurrent ischemic stroke. Methods. 50 patients who suffered a recurrent ischemic stroke in the period from October 2010 to February 2011 participated in the study. Past medical history information was obtained according to a specially designed questionnaire. Information on the regularity of medication administration (antihypertensive, antithrombotic, lipid lowering), maintenance of a diet, and modes of physical activity was collected. Results. The main measure of prevention of thrombosis in patients after an ischemic stroke was acetylsalicylic acid, 11% of patients took it regularly. The patients did not use the modern and more effective drug clopidogrel. In the group of patients with a cardioembolic ischemic stroke the recommended anticoagulation therapy with warfarin was not conducted. 89% of the patients were compliant with antihypertensive medications before the development of a recurrent stroke, however only 15 (30%) patients took the drugs regularly under blood pressure control. The majority of patients (70%) at first administered the antihypertensive medications according to the prescription instructions, but then in accordance to well-being. None of the patients knew and controled their cholesterol level. Statin therapy was not conducted in any patient. The recommended hypolipidemic diet was maintained by 44% of patients, 25% of them - routinely. The number of smokers up to the recurrence of the ischemic stroke was 66%, of which only 15.2% reduced the number of cigarettes. 10% of patients stopped drinking alcohol, 34% - decreased its use, 22% did not change the level of alcohol consumption, 34% of patients noted that they did not consume alcoholic beverages. Only 44% of patients altered their physical activity, started going for a walk in the fresh air. A decrease in adherence to therapy after an average of 2 months after initiating treatment was established. A direct relationship between the quality of prophylaxis and the time of recurrent ischemic stroke occurrence was revealed according to the following parameters: normalization of the blood pressure levels, antithrombotic therapy, control of blood glucose levels, termination of smoking, cessation of alcohol abuse. Conclusion. The majority of the patients did not take the necessary measures for the prevention of ischemic stroke; organization of educational activities is necessary to raise awareness among the patients about this disease.

Keywords

recurrent ischemic stroke / secondary prophylaxis / risk factors / antithrombotic therapy / antihypertensive therapy

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RIGHTS & PERMISSIONS

Vasilevskaya O.V., Safina D.D., Silant’eva I.V.