Prescription of secondary preventive drugs after ischemic stroke: results from the Malaysian National Stroke Registry

Abstract

Background: Evaluation of secondary stroke prevention in low and middle-income countries remains limited. This study assessed the prescription of secondary preventive drugs among ischemic stroke patients upon hospital discharge in Malaysia and identified factors related to the prescribing decisions.

Methods: From Malaysian National Stroke Registry, we included patients with non-fatal ischemic stroke. Prescriptions of antiplatelet, anticoagulants, antihypertensive drugs and lipid-lowering drugs were assessed. Multi-level logistic regressions were performed to determine the relation between potential factors and drug prescriptions.

Results: Of 5292 patients, 48% received antihypertensive drugs, 88.9% antiplatelet and 88.7% lipid-lowering drugs upon discharge. Thirty-three percent of patients with an indication for anticoagulants (n = 391) received it. Compared to patients <=50 years, patients above 70 years were less likely to receive antiplatelet (OR: 0.72, 95% CI: 0.50-1.03), lipid-lowering drugs (OR: 0.66, 95% CI: 0.45-0.95) and anticoagulants (OR: 0.27, 95% CI: 0.09-0.83). Patients with moderate to severe disability upon discharge had less odds of receiving secondary preventive drugs; an odds ratio of 0.57 (95% CI: 0.45-0.71) for antiplatelet, 0.86 (95% CI: 0.75-0.98) for antihypertensive drugs and 0.78 (95% CI: 0.63-0.97) for lipid-lowering drugs in comparison to those with minor disability. Having prior specific comorbidities and drug prescriptions significantly increased the odds of receiving these drugs. No differences were found between sexes and ethnicities.

Conclusions: Prescription of antihypertensive drugs and anticoagulants among ischemic stroke patients in Malaysia were suboptimal. Efforts to initiate regular clinical audits to evaluate the uptake and effectiveness of secondary preventive strategies are timely in low and middle-income settings.

Keywords: Anticoagulants; Antihypertensive agents; Brain ischemia; Hydroxymethylglutaryl-CoA reductase inhibitors; Platelet aggregation inhibitors; Secondary prevention.

Fig. 1

Prescription of secondary preventive drugs. *for ischemic stroke patients with indications to receive anticoagulants (n = 391)

Fig. 2

Types of antithrombotic drugs prescribed among ischemic stroke patients with indications for anticoagulation. (n = 391). *exploded slice from the pie chart indicates the proportion of patients who were not prescribed with any antithrombotic drugs

Fig. 3

Factors related to the prescription of secondary preventive drugs among ischemic stroke patients. (Fig. 3 a–d are results from multivariable analyses, ref. = reference groups, TIA = transient ischemic attack, mRS = Modified Rankin Scale, − = factors were not included in multivariable analysis). *atrial fibrillation includes patients with documented history of atrial fibrillation and patients with electrocardiogram showing atrial fibrillation during admission for ischemic stroke. †state hospitals refer to hospitals with up to 45 resident specialties or subspecialties and are normally main referral centers for each state