NEW ORLEANS – Roughly 40% of patients who survive a stroke do not take aspirin on a daily basis, despite established guidelines that recommend its use for secondary prevention in this population, investigators announced at the 2012 International Stroke Conference.
Dr. John G. Fort, Chief Medical Officer of POZEN Inc. in Chapel Hill, North Carolina, presented data from an Internet-based questionnaire that aimed to determine aspirin use in patients who had experienced a myocardial infarction (MI) or stroke.
The American Heart Association has issued guidelines recommending anti-platelet therapy to reduce the risk of recurrent stroke or other cardiovascular events in patients with prior noncardioembolic stroke or transient ischemic attack, he explained. Among the accepted options for initial therapy, is aspirin 50 to 325 mg daily. The recommendation is based on Class 1, Level A evidence.
The present analysis, conducted in 2009, included 500 total stroke households (350 patients with stroke only and 150 patients with both stroke and MI) and 500 MI-only households.
Results showed that 56% of stroke-only patients reported aspirin use, versus 88% of patients who had sustained an MI only.
While the most common aspirin dosing regimen for stroke survivors was 81 mg (51%), one-third reported taking 325 mg.
Overall, 95% of stroke patients who reported using aspirin said they took it once daily.
The use of aspirin with a prescription proton pump inhibitor (PPI) was highest in those patients who had had both a stroke and MI. Proton pump inhibitors are the preferred agents for the prophylaxis and treatment of aspirin-associated gastrointestinal (GI) injury in patients who are at risk of GI adverse events.
The survey also found that cardiologists and general practitioners were more likely to recommend aspirin therapy in the total stroke population than neurologists. Stroke patients identified cardiologists and general practitioners as their primary health care provider.
Dr. Fort said that the results are similar to those reported by the Agency for Healthcare Research and Quality (AHRQ) survey in 2006. The AHRQ survey found that 57% of stroke survivors reported using aspirin. When the analysis excluded patients who stated that aspirin use was unsafe, aspirin use was recalculated to be 70%. The present study did not examine why patients were not taking aspirin.
“It appears that a relatively high percentage of patients who should be taking aspirin are, in fact, not taking aspirin…and this may raises some important questions with significant clinical implications,” Dr. Mark J. Alberts, Chief of the Division of Stroke and Cerebrovascular Disease at Northwestern University in Chicago, commented in a news release.
He added that while patients may have been taking other antiplatelet or anticoagulant agents, “many patients simply stop taking aspirin for unclear reasons.” Stroke survivors who do not use aspirin regularly have an increased risk of recurrent stroke or MI.
Dr. Alberts said that the survey findings underscore the need for further study along with the identification of improved strategies to promote the appropriate use of aspirin and other medications for the secondary prevention of cardiovascular disease.
The study was sponsored by POZEN Inc. The company’s lead pipeline product PA32540 is being tested for the secondary prevention of cardiovascular disease in patients at risk of aspirin-associated gastric ulcers.
Written by Jill Stein
Jill Stein is a Paris-based freelance medical writer.