Non-persistence with antiplatelet therapy in elderly patients after a transient ischemic attack

• Published in: Aging clinical and experimental research 2017-12, Vol.29 (6), p.1121-1127
• Main Authors: Wawruch, Martin, Zatko, Dusan, Wimmer, Gejza, Luha, Jan, Wimmerova, Sona, Kukumberg, Peter, Murin, Jan, Hloska, Adam, Tesar, Tomas, Shah, Rashmi
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Databases, Factual; Female; Geriatrics/Gerontology; Humans; Ischemic Attack, Transient - prevention & control; Male; Medication Adherence - statistics & numerical data; Medicine; Medicine & Public Health; Original Article; Patients; Platelet Aggregation Inhibitors - therapeutic use; Polypharmacy; Proportional Hazards Models; Retrospective Studies; Secondary Prevention; Slovakia; Stroke - prevention & control
• ISSN: 1720-8319; 1594-0667; 1720-8319
• DOI: 10.1007/s40520-017-0745-4

Background Antiplatelet therapy following a transient ischemic attack (TIA) constitutes an important secondary prevention measure. Aims The study was aimed at evaluating the development of non-persistence with antiplatelet therapy in elderly patients after a TIA and identifying patient-related characteristics associated with the probability of non-persistence during the follow-up period. Methods The study cohort ( n  = 854) was selected from the database of the largest health insurance provider of the Slovak Republic. It included patients aged ≥65 years, in whom antiplatelet medication was initiated following a TIA diagnosis during the period between 1 January 2010 and 31 December 2010. Each patient was followed for a period of 3 years from the date of the first antiplatelet medication prescription associated with TIA diagnosis. Patients in whom there was a treatment gap of at least 6 months without antiplatelet medication prescription were defined as “non-persistent”. The factors predicting non-persistence were identified in the Cox proportional hazards model. Results At the end of the follow-up period, 345 (40.4%) patients were non-persistent with antiplatelet medication. Protective factors decreasing a patient´s likelihood of becoming non-persistent were age ≥75 years [hazard ratio (HR) = 0.75], polypharmacy (concurrent use of ≥6 drugs) (HR = 0.79), arterial hypertension (HR = 0.68), diabetes mellitus (HR = 0.74), hypercholesterolemia (HR = 0.75), and antiplatelet medication switching during the follow-up period (HR = 0.73). Conclusions It is concluded that following a TIA, elderly patients aged