Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta‐analysis

Abstract

Objectives We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke. Methods We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle–Ottawa scale. Where possible, data were pooled using random‐effects meta‐analysis. Results We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%–68%), and 68% (95% CI: 58%–79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%–93%). It was reported that 11% (95% CI: 2%–19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%–89%), 71% (95% CI: 57%–84%), and 73% (95% CI: 59%–86%), respectively. Conclusion In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.

Persistence and Adherence to Cardiovascular Medicines in Australia

“…Our results were broadly consistent with several observational studies conducted in Australia 11 , 17 , 27 and other jurisdictions internationally, 8 , 25 , 31 although not directly comparable due to differences in setting, study population, and outcome definitions. Adherence and persistence rates varied substantially between CVD groups.…”

“…We also found lower adherence among anticoagulant and antiplatelet users, particularly 2 and 3 years after initiation. Although adherence rates for antihypertensives and statins are broadly consistent with previous Australian studies, there is less consistence in reported adherence rates for anticoagulants (42%–80%) 9 , 23 , 31 , 32 and antiplatelets (39%–79%). 31 , 32 However, persistence within the first year of initiation is usually high for antiplatelets (55%–89%) 13 , 14 and anticoagulants (69%–74%).…”

“… 11 , 30 Such correlations between health need and engagement with care explain our finding that younger people (more often healthier) were less likely to adhere and persist to therapy than older people, despite controversies about the effect of age on adherence and persistence to cardiovascular medicines. 25 , 31 …”

Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?

“…The treatment of choice to prevent another ischemic stroke is a long-term oral anticoagulant or antiplatelet strategy. However, many patients cannot take such drugs due to long-term contraindications, comorbidities, cognitive impairment, severe walking difficulties with frequent falls, and patient refusal [25,26]. The risk of death or addiction, as well as the risk of stroke recurrence in this group, is also not well known but must certainly be considered [25,26].…”

“…However, many patients cannot take such drugs due to long-term contraindications, comorbidities, cognitive impairment, severe walking difficulties with frequent falls, and patient refusal [25,26]. The risk of death or addiction, as well as the risk of stroke recurrence in this group, is also not well known but must certainly be considered [25,26]. The presence of ongoing bleeding causes a series of problems for patients who, at risk of thromboembolic events, take antiplatelet or anticoagulant therapy [27,28].…”