Vol 47, No 6 (2013)

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Pharmacotherapy prior to and in acute haemorrhagic stroke. The use of pharmacotherapy and drugs-associated outcomes in real-world practice – findings from the Polish Hospital Stroke Registry

Maciej Niewada1, Marta Skowrońska2, Iwona Marta Sarzyńska-Długosz2, Bogumił Kamiński3, Adam Kobayashi1, Anna Członkowska1
DOI: 10.5114/ninp.2013.39068
Neurol Neurochir Pol 2013;47(6):517-524.

Abstract

Background and purpose

Haemorrhagic stroke is associated with substantial mortality and disability, thus prevention and appropriate treatment of acute intracerebral haemorrhage is crucial. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute haemorrhagic stroke in a real-world practice.

Material and methods

Haemorrhagic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, authorized access, web-based questionnaire. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute haemorrhagic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency – modified Rankin Scale ≥ 3) at hospital discharge, while late outcomes covered one-year survival.

Results

A total of 3111 haemorrhagic stroke patients (mean age: 68.9 years; females: 46.7%) was reported. The analysis of pharmacotherapy showed low preventive use of hypotensive agents in hypertensive patients, high consumption of antibiotics and still overuse of vasoactive or neuroprotective compounds in acute haemorrhagic stroke. Regression models confirmed expected negative impact on stroke outcomes associated with oral anticoagulants but not antiplatelets and inconsistent impact of statins used prior to or in acute haemorrhagic stroke.

Conclusions

Preventive underuse of hypotensive compounds contribute substantially to haemorrhagic stroke risk. The high consumption of antibiotics and neuroprotective or vasoactive compounds in haemorrhagic acute stroke reflect the need to improved quality and evidence-based clinical practice.

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Neurologia i Neurochirurgia Polska