Many pa­tients at risk for stroke get wrong medicine

Pakistan Observer - - KARACHI CITY -

MORE than a third of pa­tients with a heart rhythm prob­lem that can cause a stroke are in­cor­rectly given as­pirin in­stead of the blood-thin­ning med­i­ca­tions they need to make this com­pli­ca­tion less likely, a U.S. study sug­gests.

Most strokes oc­cur when an artery that car­ries blood to the brain gets blocked by a clot. While as­pirin can pre­vent clots, it doesn’t work well as blood thin­ners to pre­vent stroke in th­ese pa­tients, guide­lines say.

Re­searchers an­a­lyzed data on more than 500,000 peo­ple with atrial fib­ril­la­tion, an ir­reg­u­lar rapid heart­beat that can lead to stroke, heart fail­ure and chronic fa­tigue.

Roughly 40 per­cent of th­ese pa­tients got as­pirin in­stead of pre­scrip­tions for blood thin­ners – also called an­ti­co­ag­u­lants. “By pre­scrib­ing as­pirin, we may be fool­ing our­selves that the pa­tient may be pro­tected from stroke when this is not the case – blood thin­ners have been shown to be clearly more ef­fec­tive than as­pirin in pre­vent­ing stroke for atrial fib­ril­la­tion pa­tients,” lead study au­thor Dr. Jonathan Hsu, a heart spe­cial­ist at the Uni­ver­sity of Cal­i­for­nia, San Diego, said by email.

In atrial fib­ril­la­tion, elec­tri­cal im­pulses in the up­per chambers of the heart are chaotic, and the atrial walls quiver rather than con­tract­ing nor­mally. As a re­sult, blood doesn’t move as well to the heart’s lower chambers. This can lead to the for­ma­tion of clots that can travel through the ar­ter­ies. Atrial fib­ril­la­tion pa­tients have up to seven times the stroke risk of peo­ple with­out the dis­or­der. To see how many atrial fib­ril­la­tion pa­tients re­ceive blood thin­ners to avert clots, Hsu and col­leagues re­viewed med­i­cal and pre­scrip­tion data col­lected from 2008 to 2012 in a na­tional reg­istry of peo­ple with car­dio­vas­cu­lar dis­ease.

One group of about 210,000 peo­ple in the study were at least 75 years old and had other risk fac­tors for stroke such as con­ges­tive heart fail­ure, di­a­betes, or high blood pres­sure. Roughly 38 per­cent of th­ese pa­tients were treated with as­pirin and nearly 62 per­cent were pre­scribed an­ti­co­ag­u­lants.

A sec­ond group of roughly 295,000 peo­ple were be­tween 65 and 74 years old. Among this sub­set of atrial fib­ril­la­tion pa­tients, 40 per­cent were treated with as­pirin and 60 per­cent got an­ti­co­ag­u­lants.

For both groups, pa­tients pre­scribed as­pirin were younger, slightly less over­weight, and more likely to be fe­male or have other med­i­cal prob­lems such as di­a­betes, hy­per­ten­sion, high choles­terol, coro­nary artery dis­ease, a prior heart at­tack or pe­riph­eral artery dis­ease, re­searchers re­port in the Jour­nal of the Amer­i­can Col­lege of Car­di­ol­ogy. The pos­si­bil­ity of side ef­fects may partly ex­plain the lim­ited use of blood thin­ners.

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