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Master Thesis

Qualités et disparités de prise en charge pharmacologique post-AVC en région Aquitaine : Apport du registre ObA2

Abstract : Aim: Ischemic stroke secondary prevention involves antithrombotic, antihypertensive and lipid-lowering drugs, whose association could reduce the risk of a cardiovascular event by 80 %. Unfortunately, clinical practice is far behind. The main purpose was to investigate the gap between evidence-based recommendations and clinical practice in patients hospitalized for acute ischemic stroke, and to assess the factors underlying this gap. The secondary aim was to investigate a causal link between anterior medications and post-stroke complications. Methods: This retrospective study included patients with a diagnosis of acute ischemic stroke validated by an expert neurologist from the ObA2 registry, hospitalized in eight health centers in Aquitaine, between 2012 and 2014. Data on medical history, prior use of treatment and complications were collected. The gap between prescriptions at discharge and evidence-based recommendations was defined for each patient with regard to a triple combination therapy (antihypertensive, antithrombotic and lipid-lowering drugs). Results: Among 4187 patients recorded, only 1494 (35.7 %) received the optimal triple combination therapy. The prescription gap increased with NIH stroke scale and being hospitalized in a hospital without stroke unit, and decreased with age and cardiovascular risk factors or medical history (p<0.005). Secondary analysis showed correlation between psychotropic drugs and confusion (p=0.004) and between previous antiarrhythmic medication and probability of discovering an atrial fibrillation (p<0.001). Discussion: There is evidence for a gap between recommendations and clinical practice, and heterogeneity of prescriptions according to the health center. A solution could be to increase the number of neurologists active in the territory. The high-risk patients seem to be well cared, but some risk factors are underestimated. Primary prevention could be intensified as our results only highlight only a weak association between previous medications and complications of ischemic stroke.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01245723
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Submitted on : Thursday, December 17, 2015 - 3:29:45 PM
Last modification on : Wednesday, August 23, 2017 - 4:32:37 PM
Long-term archiving on: : Friday, March 18, 2016 - 2:10:14 PM

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Idoia Marie Lacoste Dagens. Qualités et disparités de prise en charge pharmacologique post-AVC en région Aquitaine : Apport du registre ObA2. Médecine humaine et pathologie. 2015. ⟨dumas-01245723⟩

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