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Yeo SH, Toh MPHS, Lee SH, Seet RCS, Wong LY, Yau WP. Temporal Trends and Patient Characteristics Associated With Drug Utilisation After
First-Ever Stroke: Insights From Chronic Disease Registry Data in Singapore. ANNALS ACADEMY OF MEDICINE SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2019196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Data on drug utilisation among stroke patients of Asian ethnicities are
lacking. The objectives of the study were to examine the temporal trends and patient
characteristics associated with prescription of thrombolytic, antithrombotic and statin
medications among patients with first-ever stroke. Materials and Methods: First-ever
ischaemic and haemorrhagic stroke patients admitted to 2 Singapore tertiary hospitals
between 2010‒2014 were included. Data were extracted from the National Healthcare
Group Chronic Disease Management System. Association between drug utilisation and
admission year, as well as characteristics associated with drug use, were explored using multivariable logistic regression. Results: There was an increasing trend in the combined use of all 3 guideline medications in ischaemic stroke patients (P<0.001) ―specifically thrombolytic agents (P <0.001), oral antithrombotics (P = 0.002) and statins (P = 0.003) at discharge. Among antithrombotics, the use of clopidogrel (P <0.001) and aspirinclopidogrel (P <0.001) had increased, whereas prescription of dipyridamole (P <0.001) and aspirin-dipyridamole (P <0.001) had declined. For statins, the increase in atorvastatin prescription (P <0.001) was accompanied by decreasing use of simvastatin (P <0.001). Age, ethnicity and certain comorbidities (hyperlipidaemia, atrial fibrillation and chronic kidney disease) were associated with the combined use of all 3 guideline medications (P <0.05). In haemorrhagic stroke, prescription of statins at discharge were comparatively lower. Conclusion: This study reveals changes in prescription behaviour over time in a multiethnic Asian population with first-ever stroke. Patient characteristics including younger age, Malay ethnicity and certain comorbidities (i.e. hyperlipidaemia, atrial fibrillation) were associated with the combined use of all 3 guideline medications among ischaemic stroke patients.
Key words: Antithrombotics, Asian, Statins, Thrombolytic agents
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Affiliation(s)
| | - Matthias Paul HS Toh
- National Healthcare Group, Singapore.National University of Singapore, Singapore
| | - Sze Haur Lee
- National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore
| | - Raymond CS Seet
- National University of Singapore, Singapore. National University Health System, Singapore
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