Stroke-preventing medications are often abandoned, study shows

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 Monday 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.

Many paths — including high blood pressure, high cholesterol, uncontrolled diabetes — lead to strokes or transient ischemic attacks. As a result, the best way to prevent a repeat stroke is not always certain. Nor is it perfectly clear how well medications work to prevent a second event. But there’s early evidence that they can make a difference — if the patient takes those medications.

UCLA researchers were among the first to gauge the impact of aggressive efforts to prevent a second stroke. When stroke patients did not comply with doctors’ orders to stop smoking, exercise, watch their diet and take medications to keep blood pressure, cholesterol or diabetes under control, UCLA researchers in 2008 found they were almost three times as likely as those who had complied to suffer another “event,” such as a stroke or heart attack.

There’s a lot to deal with in the wake of a stroke. Here’s a primer for stroke patients and their caregivers.

-- Melissa Healy / Los Angeles Times