uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Ischemic Stroke and Secondary Prevention in Clinical Practice: A Cohort Study of 14 529 Patients in the Swedish Stroke Register
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Akut- och internmedicin)
Show others and affiliations
2010 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 41, no 7, 1338-1342 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose

Secondary prevention is recommended after stroke, but adherence to guidelines is unknown. We studied the prescription of antiplatelet drugs, angiotensin-converting enzyme inhibitors, statins, and anticoagulant drugs and their relation to risk of death.


Patients with first-ever ischemic stroke in 2005 were registered in the Swedish Stroke Register. Odds ratios, hazard ratios, and 95% CIs were calculated using logistic and Cox proportional hazard regression models. Adjustments were performed for age, sex, cardiovascular risk factors, other drug therapies, and activities of daily living function.


In total, 14 529 patients with a mean age of 75.0 (±11.6) years were included. They were followed for 1.4 (±0.5) years: 52% had hypertension, 26% atrial fibrillation, 19% diabetes, and 15% were smokers. The odds ratio for prescription of antiplatelet was 2.20 (95% CI, 1.86 to 2.60) among the oldest patients (≥85 years of age) compared with the youngest (18 to 64 years of age). The corresponding odds ratio was 0.38 (0.32 to 0.45) for prescriptions of angiotensin-converting enzyme inhibitors, 0.09 (0.08 to 0.11) for statins, and 0.07 (0.05 to 0.09) for anticoagulant therapy. Prescription of statin and anticoagulant therapy was associated with reduced risk of death (hazard ratio, 0.78 [0.65 to 0.91] and hazard ratio, 0.58 [0.44 to 0.76], respectively) but not the prescription of antiplatelet drugs or angiotensin-converting enzyme inhibitors.


The prescription of antiplatelet, angiotensin-converting enzyme inhibitors, statins, and anticoagulant therapy was strongly age related. Statin and anticoagulant therapy was associated with reduced risk of death and seemed to be underused among elderly patients. These findings should encourage physicians to follow today's guidelines for stroke care.

Place, publisher, year, edition, pages
2010. Vol. 41, no 7, 1338-1342 p.
Keyword [en]
cerebral infarction, risk factors, secondary prevention, age groups
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-135177DOI: 10.1161/STROKEAHA.110.580209ISI: 000279272200008PubMedID: 20522818OAI: oai:DiVA.org:uu-135177DiVA: diva2:374622
Available from: 2010-12-06 Created: 2010-12-06 Last updated: 2012-08-01Bibliographically approved
In thesis
1. Outcome of Stroke Prevention: Analyses Based on Data from Riks-Stroke and Other Swedish National Registers
Open this publication in new window or tab >>Outcome of Stroke Prevention: Analyses Based on Data from Riks-Stroke and Other Swedish National Registers
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore variations in stroke prevention and the effect of prevention on outcome. The studies were based on patients registered in the Swedish Stroke Register between 2001 and 2009 and although used to different extents in each paper, additional information was retrieved through linkage to The National Patient Register, the Cause of Death Register, the Prescribed Drug Register and the Total Population Register.

Cardiovascular risk factors were prevalent among ischemic stroke (IS) patients; however, they were not always prescribed the drugs recommended, and increasing age was an important negative predictor (Paper I).

After IS, the rate of hemorrhage in patients prescribed antiplatelet agents (2.4 per 100 person-years) was double to results from randomized controlled trails, but was similar for patients prescribed warfarin (2.5 per 100 person-years).  Age ≥75 years and previous hemorrhage were associated with a moderately increased risk of future hemorrhage (Paper II).

Among IS patients with atrial fibrillation, one-third was prescribed warfarin and two-thirds were prescribed antiplatelets. After adjustment for a propensity score (used to adjust for the non-randomized design), warfarin was associated with a reduced risk of death (0.67; 95% CI, 0.63-0.71) (Paper III). The rate of subsequent hemorrhagic stroke was 0.4 per 100 person-years and the risk did not change (HR 1.04; 95% CI, 0.73-1.48) when later years of the 2000s (inclusion period 2005-8: follow-up until 2009) was compared with earlier years (inclusion period 2001-4: follow-up until 2005) (Paper IV, cohort).

Although the risk of first-ever hemorrhagic stroke more than doubled with warfarin than without, the risk did not change between 2006 and 2009 (Paper IV, case-control).

In summary, the prescription of secondary preventive drugs varies with age, even though cardiovascular risk factors are prevalent in all ages. The risk of death and hemorrhage are affected by the type of antithrombotic prescribed. Therefore, it is important individual’s stroke and bleeding risks in stroke prevention are assessed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 52 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 757
Stroke, Epidemiology, Age groups, Risk factors, Atrial fibrillation, Secondary prevention, Anticoagulants, Antiplatelets, Hemorrhage, Mortality.
National Category
Clinical Medicine
Research subject
Medical Science
urn:nbn:se:uu:diva-171871 (URN)978-91-554-8322-7 (ISBN)
Public defence
2012-05-16, Enghoffsalen, ing 50, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Available from: 2012-04-24 Created: 2012-03-28 Last updated: 2012-08-01Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMedhttp://stroke.ahajournals.org/cgi/reprint/STROKEAHA.110.580209?ijkey=QBz0TETeDNzBSlN&keytype=ref

Search in DiVA

By author/editor
Åsberg, Signild
By organisation
Department of Medical Sciences
In the same journal
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 287 hits
ReferencesLink to record
Permanent link

Direct link