The Investigation And Analysis Of Dual Antiplatelet Therapy In 288 Patients With Ischemic Stroke

Objective:To investigate the situation of dual antiplatelet therapy in 288 patients with ischemic stroke,and analyze the reasons for not using the dual antiplatelet drugsrecommended by the guidelines,so as to clarify the gap between current clinical treatment practice and evidence-based guidelines.Instructing patients with a more scientifically and rationally to use dual anti-platelet drugs.Methods:Retrospectively collected medical records of patients admitted to our neurology department from August 2016 to September 2017 using dual antiplatelet aggregation drugs(aspirin plus clopidogrel)and diagnosed as ischemic stroke or TIA.Patients were followed up by telephone,registered the specific combination forms and application time of dual antiplatelet drugs.Recorded the reasons who had stopped or not taking antiplatelet drugs,and the ischemic events(recurrent cerebral infarction or TIA),bleeding events(intracranial hemorrhage,gastrointestinal bleeding,skin mucosal hemorrhage,etc.)and anti-platelet drug-related adverse reactions during follow-up.Statistical analysis was performed using statistical software SPSS 19.0 version,P < 0.05 was statistically significant.Results:Of the 288 patients enrolled,96(33.3%)were guideline followed group and 192(66.7%)were non-guideline followed group.The patients in the guideline followed group were older and had a higher proportion of hypertension(P<0.05).At the end of follow-up,39 patients(13.5%)had recurrent cerebral ischemic stroke/TIA.Diabetes and the non-standard use of dual antiplatelet therapy recommended by guideline were associated with recurrence(P<0.05).Patients who did not follow the guidelines had a higher rate of recurrent stroke than those who followed the guidelines.(P <0.05,OR=0.239,95%CI 0.089-0.640).Patients with diabetes had higher rates of recurrent stroke(P < 0.05,OR=2.839,95%CI 1.396-5.775).Among all the reasons for not following the guidelines for dual antiplatelet therapy,32.3% of the patients stopped taking the medicine due to symptoms improved or self-conscious invalidity.Conclusions : There is still a big gap between clinical practice and evidence-based guidelines for dual antiplatelet therapy,and 2/3 patients did not follow the guidelines for recommendation use of dual antiplatelet drugs.Failure to follow the guidelines recommendations for the use of dual antiplatelet therapy and diabetes are independent risk factors for stroke recurrence.