Situation Of The Compliance Of Antiplatelet Drugs And Their Relation With Stroke Recurrence

Objective: The disease spectrum gradually evolves with the development of society and economy, at present, brain stroke has been a leading disease that causes death and disability in China, it poses a severe threat to the health and survival of humankind. The brain stroke includes hemorrhagic stroke and ischemic stroke(cerebral infarction). In contrast to other diseases, the cerebral infarction has a high rate in morbidity, disability, death and recurrence, its age of onset increasingly becomes younger and its morbidity becomes higher year by year. Aspirin and clopidogrel hydrogen sulfate are the drugs that are most widely used for the secondary prevention against ischemic stroke by far, they can inhibit the activation of blood platelet through different approaches, and consequently inhibit the formation of thrombus, however, in clinical practice, the using rate of aspirin and clopidogrel is not satisfying, which brings about a great difficulty to the prevention against brain stroke. This study is aimed at making a understanding of the using situation and reason of drug withdrawal of aspirin and clopidogrel hydrogen sulfate within one year since the discharge of patients with brain stroke, and analyzing the relationship between the compliance of antiplatelet drug and recurrence of brain stroke, so as to provide a reliable foundation for the education and implementation of secondary prevention against brain stroke.Methods: The data of 698 cases of patients with brain stroke admitted and hospitalized in neurology department of the second hospital of Hebei Medical University from Sept, 30 th, 2014 to Jan, 30 th, 2015 was collected, all the cases conformed to the diagnostic criteria set up in the fourth conference of cerebrovascular diseases in 1995, they were divided into aspirin group(treated with aspirin upon discharge)and clopidogrel group(treated with clopidogrel hydrogen sulfate upon discharge), the differences between both groups of patient in terms of gender, age, past medical history and other aspects were equally not statistically significant.Through the approach of telephone follow- up visit, the knowledge of situation of drug use(aspirin or clopidogrel), reason of drug withdrawal as well as recurrence of the patients with brain stroke were obtained, the SPSS20.0 statistical software package was used to do a statistical analysis on them, if P<0.05, it is regarded as being statistically significant.Results:1 The aspirin-use rate of the patients in aspirin group in 3 months, 6 months and one year since discharge was respectively 98.5%, 88.7% and 83.6%, among which, the difference between one year and 6 months was not statistically significant(P>0.05), the difference in other pairwise comparisons were all statistically significant(P<0.005).2 The clopidogrel-use rate of the patients in clopidogrel group in 3 months, 6 months and one year since discharge was respectively 74%, 61.9% and 55.1%, among which, the difference between one year and 6 months was not statistically significant(P>0.05), the difference in other pairwise comparisons were all statistically significant(P<0.005).3 With one-year follow up visit of the patients in aspirin group, the recurrence rate of the group with a good aspirin compliance and the one with a poor aspirin compliance was respectively 13.1% and 30.9%, the difference between the two groups was statistically significant(P<0.005).4 With one-year follow up visit of the patients in clopidogrel group, the recurrence rate of the group with a good clopidogrel compliance and the one with a poor clopidogrel compliance was respectively 11.6% and 21.8%, the difference between the two groups was statistically significant(P<0.005).5 With one-year follow up visit of the patients with brain stroke, the recurrence rate of brain stroke of the patients with a good clopidogrel compliance and the ones with a good aspirin compliance was respectively 11.6% and 13.1%, the difference between both was not statistically significant(P>0.05).6 The distribution of reason of drug withdrawal of the patients in aspirin group was: voluntarily withdrawal owing to symptom improvement(25.5%), transfusion prevention or changed to other drugs(17.0%), the patients thought they didn't need to take drugs(12.8%), afraid of side effect(12.8%), poor curative effect(10.6%), side effect(10.6%), uncertain about the drug-use duration(6.4%)and economic factors(4.3%).7 The distribution of reason of drug withdrawal of the patients in clopidogrel group was: voluntarily withdrawal owing to symptom improvement(16.9%), transfusion prevention or changed to other drugs(13.3%), the patients thought they didn't need to take drugs(19.3%), afraid of side effect(6%), poor curative effect(6%), side effect(3.6%), uncertain about the drug-use duration(14.5%)and economic factors(20.5%).Conclusions:1 The medication compliance of the patients with brain stroke taking antiplatelet drugs was poor, and it gradually dropped as the time passed within 6 months since discharge, after 6 months since discharge, the decline of drug-use rate was not significant.2 the medication compliance of clopidogrel was lower than that of aspirin, the main reason of withdrawal of clopidogrel was due to economic factors.3 the medication compliance of the patients with brain stroke taking antiplatelet drugs was associated with recurrence of stroke, they had a good medication compliance with a low recurrence rate of stroke.4 the curative effect of clopidogrel in the secondary prevention against brain stroke was equivalent to that of aspirin, no significant difference was found.