Secondary Prevention After Ischemic Stroke and Transient Ischemic Attack in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.63719/johm.v23i1.238Keywords:
ischemic stroke, transient ischemic attack, secondary prevention, low- and middle income countries,, systematic reviewAbstract
Background: The significance of secondary preventive measures in reducing the burden of recurrent stroke is widely recognised. Yet, consolidated information on the prescription of secondary stroke prevention in low- and middle-income countries (LMICs) remains scarce. This review aimed to quantify the prescription of secondary preventive drugs among ischemic stroke (IS) and transient ischemic attack (TIA) patients in LMICs and explore potential factors that affect the prescription rates.
Methods: In this systematic review and meta-analysis, we searched PubMed/MEDLINE, EMBASE, Web of Science, and Global Index Medicus to identify studies published between 1 January 1996 and 15 April 2021. Observational studies conducted in LMICs that evaluated the prescription of antiplatelets, statins, antihypertensives, and oral anticoagulants after a stroke event with time points upon discharge, 3, 6, and 12 months were included. Meta-analyses of the included studies were conducted using a random-effects model. Effects from potential study and clinical characteristics were estimated with a meta-regression (PROSPERO ID: CRD42017056807).
Results: From 10,250 records, 62 articles comprising 248,747 IS/TIA patients were included. Pooled estimates at hospital discharge were 85.0% (95% CI: 79.0 – 90.0%) for antiplatelets, 62.0% (95% CI: 52.0 – 72.0%) for statins, 64.0% (95% CI: 58.0 – 71.0%) for antihypertensives, and 44.0% (95% CI: 29.0 – 59.0%) for anticoagulants among IS/TIA patients with atrial fibrillation. The prescription of secondary preventive drugs decreased with time from discharge. Variations between studies were associated with temporal trends, especially statins prescription, cardiovascular comorbidities in the prescription of statins and antihypertensives, study sizes, income level, and geographical differences.
Conclusion: The prescription of statins, antihypertensives, and oral anticoagulants for secondary stroke prevention remains inadequate in LMICs. This highlights the need for a multifaceted stroke preventive strategy that addresses essential components of secondary prevention.
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