Only very limited data are available concerning patient adherence to antithrombotic medication intended to prevent a recurrent stroke. Reduced adherence and compliance could significantly influence the effects of any stroke prevention strategies. This study from a large stroke data bank provides representative data concerning the rate of stroke victims adhering to their recommended preventive medication. During a 2-year period beginning January 1, 1998, all patients with acute stroke or TIA in 23 neurological departments with an acute stroke unit were included in the German Stroke Data Bank. Data were collected prospectively, reviewed, validated and processed in a central data management unit. Only 12 centers with a follow-up rate of 80% or higher were included in this evaluation. 3,420 patients were followed up after 3 months, and 2,640 patients were followed up one year after their stroke. After one year, 96% of all patients reported still adhere to at least one medical stroke prevention strategy. Of the patients receiving aspirin at discharge, 92.6% reported to use that medication after 3 months and 84% after one year, while 81.6 and 61.6% were the respective figures for clopidogrel, and 85.2 and 77.4% for oral anticoagulation. Most patients who changed medication switched from aspirin to clopidogrel. Under the conditions of this observational study, adherence to stroke prevention strategies is excellent. The highest adherence rate is noticed for aspirin and oral anticoagulation. After one year, very few patients stopped taking stroke preventive medication.

Keywords:
Secondary stroke prevention, Adherence to medication, Aspirin, Clopidogrel, Oral anticoagulation
1.
Benavente O, Hart R, Koudstaal P, Laupacis A, McBride R: Antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks (Cochrane Review); in The Cochrane Library, Issue 1 2002, Oxford, Update Software.
2.
Hankey GJ, Sudlow CL, Dunbabin DW: Thienopyridines or aspirin to prevent stroke and other serious vascular events in patients at high risk of vascular disease? A systematic review of the evidence from randomized trials. Stroke 2000;31:1779–1784.
3.
Sacco RL, Elkind MS: Update on antiplatelet therapy for stroke prevention. Arch Intern Med 2000;160:1579–1582.
4.
Diener HC: Stroke prevention: anti-platelet and anti-thrombolytic therapy. Neurol Clin 2000;18:343–355.
5.
Easton JD, Diener HC, Bornstein NM, Einhaupl K, Gent M, Kaste M, Sacco RL, Tijssen JG, van Gijn J: Antiplatelet therapy: views from the experts. Neurology 1999;53(suppl 4):S32–S37.
6.
A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996;348:1329–1339.
7.
European Stroke Prevention Study 2: Efficacy and safety data. J Neurol Sci 1997;151(suppl):S1–S77.
8.
Komiya T, Kudo M, Urabe T, Mizuno Y: Compliance with antiplatelet therapy in patients with ischemic cerebrovascular disease. Assessment by platelet aggregation testing. Stroke 1994;25:2337–2342.
9.
Allen H: Promoting compliance with antihypertensive medication. Br J Nurs 1998;7:1252–1258.
10.
Burke LE, Dunbar-Jacob JM, Hill MN: Compliance with cardiovascular disease prevention strategies: a review of the research. Ann Behav Med 1997;19:239–263.
11.
Fonseca T, Clara JG: Polypharmacy and non-compliance in the hypertensive elderly patient. Rev Port Cardiol 2000;19:855–872.
12.
Shaw E, Anderson JG, Maloney M, Jay SJ, Fagan D: Factors associated with noncompliance of patients taking antihypertensive medications. Hosp Pharm 1995;30:201–207.
13.
Waeber B, Vetter W, Darioli R, Keller U, Brunner HR: Improved blood pressure control by monitoring compliance with antihypertensive therapy. Int J Clin Pract 1999;53:37–38.
14.
Miller P, Johnson NL, Garrett MJ, Wickoff R, McMahon M: Health beliefs of and adherence to the medical regimen by patients with ischemic heart disease. Heart Lung 1982;11:332–339.
15.
Lipton HL: Elderly patients and their pills: the role of compliance in safe and effective drug use. Pride Inst J Long Term Home Health Care 1989;8:26–31.
16.
Maronde RF, Chan LS, Larsen FJ, Strandberg LR, Laventurier MF, Sullivan SR: Underutilization of antihypertensive drugs and associated hospitalization. Med Care 1989;27:1159–1166.
17.
Mallion JM, Baguet JP, Siche JP, Tremel F, de Gaudemaris R: Compliance, electronic monitoring and antihypertensive drugs. J Hypertens Suppl 1998;16:S75–S79.
18.
The aspirin myocardial infarction study: final results. The Aspirin Myocardial Infarction Study research group. Circulation 1980;62:V79–V84.
19.
Stephenson J: Noncompliance may cause half of antihypertensive drug ‘failures’. JAMA 1999;282:313–314.
20.
Morris LS, Schulz RM: Medication compliance: the patient’s perspective. Clin Ther 1993;15:593–606.
21.
Sempere AP, Ferrero M, Tahoces ML, Duarte J, Tabernero C, Cabezas C, Guerrero P, Claveria LE: Side effects of antithrombotic treatment in the secondary prevention of cerebrovascular disease. Rev Neurol 2000;30:5–7.
22.
Silagy CA, McNeil JJ, Donnan GA, Tonkin AM, Worsam B, Campion K: Adverse effects of low-dose aspirin in a healthy elderly population. Clin Pharmacol Ther 1993;54:84–89.
23.
Elliott WJ: Compliance strategies. Curr Opin Nephrol Hypertens 1994;3:271–278.
24.
Garrett SS: Deciding between once- and twice-daily dosing. Am J Health Syst Pharm 1996;53:730–731.
25.
Caro JJ, Speckman JL: Existing treatment strategies: does noncompliance make a difference? J Hypertens Suppl 1998;16:S31–S34.
26.
Fischer B, Lehrl S, Weber E, Gundert-Remy U, Fischer U: Cerebrovascular insufficiency and compliance with drug therapy. Z Gerontol 1981;14:145–152.
27.
Insull W: Management of adherence to prescribed medication. Adv Exp Med Biol 1985;183:349–360.
28.
Schwed A, Fallab CL, Burnier M, Waeber B, Kappenberger L, Burnand B, Darioli R: Electronic monitoring of compliance to lipid-lowering therapy in clinical practice. J Clin Pharmacol 1999;39:402–409.
29.
Smith NL, Psaty BM, Heckbert SR, Tracy RP, Cornell ES: The reliability of medication inventory methods compared to serum levels of cardiovascular drugs in the elderly. J Clin Epidemiol 1999;52:143–146.
30.
Burke LE, Dunbar-Jacob J: Adherence to medication, diet, and activity recommendations: from assessment to maintenance. J Cardiovasc Nurs 1995;9:62–79.
31.
Cramer JA: Optimizing long-term patient compliance. Neurology 1995;45(suppl 1):S25–S28.
32.
Friday GH: Antihypertensive medication compliance in African-American stroke patients: behavioral epidemiology and interventions. Neuroepidemiology 1999;18:223–230.
33.
Menard J, Chatellier G: Limiting factors in the control of BP: why is there a gap between theory and practice? J Hum Hypertens 1995;(suppl 2):S19–S23.
34.
Bond WS, Hussar DA: Detection methods and strategies for improving medication compliance. Am J Hosp Pharm 1991;48:1978–1988.
35.
Eisen SA, Hanpeter JA, Kreuger LW, Gard M: Monitoring medication compliance: description of a new device. J Compliance Health Care 1987;2:131–142.
36.
Lee JY, Kusek JW, Greene PG, Bernhard S, Norris K, Smith D, Wilkening B, Wright JT: Assessing medication adherence by pill count and electronic monitoring in the African American Study of Kidney Disease and Hypertension (AASK) Pilot Study. Am J Hypertens 1996;9:719–725.
37.
Salat A, Boehm D, Pulaki S, Murabito M, Berlakovich G, Kretschmer G, Mueller MR: Possibility of checking compliance and efficacy of antiaggregatory treatment following femoro-popliteal vein bypass surgery. Thromb Res 1998;89:91–95.
38.
Maenpaa H, Heinonen OP, Manninen V: Medication compliance and serum lipid changes in the Helsinki Heart Study. Br J Clin Pharmacol 1991;32:409–415.
39.
Galt KA, Backes J, Sondag LD: Identifying noncompliance by combining refill audits with telephone follow-up. Am J Health Syst Pharm 2000;57:219–220.
40.
Inui TS, Carter WB, Pecoraro RE: Screening for noncompliance among patients with hypertension: is self-report the best available measure? Med Care 1981;19:1061–1064.
41.
Rudd P: Clinicians and patients with hypertension: unsettled issues about compliance. Am Heart J 1995;130:572–579.
42.
Algra A, van Gijn J: Aspirin at any dose above 30 mg offers only modest protection after cerebral ischaemia. J Neurol Neurosurg Psychiatry 1996;60:197–199.
43.
Weksler BB: Antiplatelet agents in stroke prevention. Combination therapy: present and future. Cerebrovasc Dis 2000;10(suppl 5):41–48.
44.
Taylor FC, Cohen H, Ebrahim S: Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation. BMJ 2001;322:321–326.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.