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Three months after suffering a stroke
or a transient ischemic attack, sometimes called a mini-stroke, one in four
patients sent home with medications prescribed to drive down the risk of a repeat
stroke or heart attack aren’t taking those medications, a new study finds. The
medication study, published online in the journal Archives of Neurology, found
that in the majority of cases, physicians are discontinuing patients’ medications
— for reasons that aren't known. But across all classes of medications prescribed
to them, small numbers of patients unilaterally discontinue their medications:
As few as 1.5% of patients who are prescribed the blood thinner warfarin quit
taking the pills on their own; as many as 4.3% of those prescribed diuretics,
which are used to control high blood pressure, stop taking the pills.
Three percent of patients who leave
the hospital with a prescription for insulin medication choose to discontinue
it on their own in the following three months. But in almost 20% of cases, doctors
withdraw insulin for stroke patients. Lipid-lowering agents — statins and non-statins
— are abandoned by 3.3% and 4% of patients, respectively. (For a look on statins
as a means of preventing heart attacks after a first heart attack, check out
Monday's article Effectiveness of statins is called into question.) The researchers
— from Wake Forest and Duke Universities in North Carolina, Harvard University
in Massachusetts and UCLA — studied the characteristics of patients to see which
ones are least likely to be on their medications three months later. They found
that younger patients and those who leave the hospital with the highest numbers
of medications, those who suffered the severest disability after their strokes
and those without health insurance are more likely to be off their medications
three months after a stroke. Older patients who understand why their medications
are prescribed, and are either employed or at home voluntarily, are more likely
to remain on medication at that point.
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