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Factors Influencing Non-Persistence with Antiplatelet Medications in Elderly Patients After Ischaemic Stroke

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Abstract

Objectives

This study investigated the extent of, and patient-related characteristics for, non-persistence with antiplatelet therapy during follow-up in elderly patients after their first ischaemic non-cardioembolic stroke.

Methods

A database of the largest health insurance provider in the Slovak Republic was used to assemble the study cohort of 4319 patients (56.8 % were women) aged ≥65 years in whom antiplatelet therapy was initiated following a hospital-based diagnosis of stroke during the period 1 January 2010 to 31 December 2010. Patients were followed for 3 years from the date on which the first prescription of antiplatelet medication was recorded. Patients with a 6-month treatment gap without antiplatelet medication prescription were designated as non-persistent, and the Cox proportional hazards model was used to identify predictors of non-persistence.

Results

At the end of the 3-year follow-up period, 1184 (27.4 %) patients were considered non-persistent with antiplatelet medication. In 1244 (28.8 %) patients, a switch in the use of a particular antiplatelet drug was registered during this follow-up period. Female sex (hazard ratio [HR] 1.25) was associated with increased risk of non-persistence. In contrast, factors associated with lower probability of non-persistence were age ≥75 years (HR 0.72), switch in antiplatelet medication use (HR 0.76), diabetes mellitus (HR 0.81), dementia (HR 0.69) and epilepsy (HR 0.69).

Conclusions

Our results suggest that women, patients aged <75 years, and patients without certain comorbid conditions may need improved assistance in secondary prevention management after an ischaemic stroke.

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Authors and Affiliations

  1. Faculty of Medicine, Institute of Pharmacology and Clinical Pharmacology, Comenius University, Sasinkova, 4, 811 08, Bratislava, Slovakia

    Martin Wawruch, Gejza Wimmer Jr, Lenka Kuzelova & Zoltan Kallay

  2. General Health Insurance Company, Bratislava, Slovakia

    Dusan Zatko

  3. Department of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia

    Jan Luha

  4. 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia

    Peter Kukumberg

  5. 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia

    Jan Murin

  6. Ministry of Health of the Slovak Republic, Bratislava, Slovakia

    Adam Hloska

  7. Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia

    Adam Hloska

  8. Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia

    Tomas Tesar

  9. Gerrards Cross, UK

    Rashmi Shah

Authors
  1. Martin Wawruch
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  2. Dusan Zatko
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  11. Rashmi Shah
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Corresponding author

Correspondence to Martin Wawruch.

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Funding

This study was funded by grants from the Scientific Grant Agency of the Ministry of Education, Science, Research and Sport of the Slovak Republic (VEGA 1/0886/14 and VEGA 1/0939/14). The providers of these Grants played no role in the design, methods, data collection, analysis and interpretation of the data, preparation of the paper or the decision to submit the manuscript.

Conflict of interest

Martin Wawruch, Dusan Zatko, Gejza Wimmer Jr, Jan Luha, Lenka Kuzelova, Peter Kukumberg, Jan Murin, Adam Hloska, Tomas Tesar, Zoltan Kallay and Rashmi Shah declare that they have no conflicts of interest.

Ethical approval

Under applicable legal instruments of our country, the study did not require the approval of an Ethical Committee. The laws and rules of personal data confidentiality were fully complied with.

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Wawruch, M., Zatko, D., Wimmer, G. et al. Factors Influencing Non-Persistence with Antiplatelet Medications in Elderly Patients After Ischaemic Stroke. Drugs Aging 33, 365–373 (2016). https://doi.org/10.1007/s40266-016-0365-2

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  • DOI: https://doi.org/10.1007/s40266-016-0365-2

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