Impact of persistence with antiplatelet therapy on recurrent ischemic stroke and predictors of nonpersistence among ischemic stroke survivors

Burke, J. P.; Sander, Stephen; Shah, Hemal; Zarotsky, Victoria; Henk, Henry J.

doi:10.1185/03007991003670563

Cited by 37 publications

(50 citation statements)

References 18 publications

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“…Our results on the risk of stroke recurrence in association with discontinuation of antiplatelet treatment are in line with the results of the previous studies, in spite of the varying definitions of discontinuation of antiplatelet use employed in these studies [10,11,19,20]. We note that our results are also in line with those of the only other study that also analysed the recently discontinued antiplatelet use and reported a relative risk of stroke or transient ischaemic attack for recently discontinued antiplatelet use of 1.40 (95% CI: 1.03-1.92) and for past discontinued use of 1.25 (95% CI: 0.81-1.97) [21].…”

Section: Discussionsupporting

confidence: 82%

“…Therefore, lifelong use of antiplatelet drugs is recommended in both Danish and international guidelines on stroke treatment [5,6]. However, long-term, nonpersistence and non-adherence to antiplatelet drugs in patients with cerebrovascular disease is a frequent problem [7,8,9], and undermines the beneficial effects of these drugs [10,11]. We designed the present study to determine the relative risk of recurrent stroke or death associated with the discontinuation of antiplatelet drugs in a cohort of stroke patients in Denmark.…”

Section: Introductionmentioning

confidence: 99%

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Discontinuation of Antiplatelet Treatment and Risk of Recurrent Stroke and All-Cause Death: A Cohort Study

et al. 2014

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Background: We wished to examine the impact of antiplatelet drug discontinuation on recurrent stroke and all-cause mortality. Methods: We identified a cohort of incident ischaemic stroke patients in a Danish stroke registry, 2007-2011. Using population-based registries we assessed subjects' drug use and followed them up for stroke recurrence, or all-cause death. Person-time was classified by antiplatelet drug use into current use, recent use (≤150 days after last use), and non-use (>150 days after last use). Lipid-lowering drug (LLD) use was classified by the same rules. We used Cox proportional hazard models to calculate the adjusted hazard ratio (HR) and corresponding 95% confidence intervals (CIs) for the risk of recurrent stroke or death associated with discontinuation of antiplatelet or LLD drugs. Results: Among 4,670 stroke patients followed up for up a median of 1.5 years, 237 experienced a second stroke and 600 died. Compared with current antiplatelet drug use, both recent use (1.3 (0.8-2.0)), and non-use (1.3 (0.8-1.9)) were associated with increased recurrent stroke risk. The corresponding HRs of death were 1.9 (1.4-2.5) for recent and 1.8 (1.4-2.3) for non-use of antiplatelet drugs. Recent statin use was associated with markedly increased risk of death (2.1 (1.7-2.6)), and only marginally with recurrent stroke (1.2 (0.9-1.6)). Conclusions: Antiplatelet drugdiscontinuation may be associated with an increased recurrent stroke risk. Our results on death risk indicate that non-pharmacological biases, such as ‘sick stopper', may threaten the validity of this risk estimate.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Discontinuation of Antiplatelet Treatment and Risk of Recurrent Stroke and All-Cause Death: A Cohort Study

et al. 2014

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“…Among the patients following treatment protocols, adherence to each isolated class was good, above 85% at 3 years and above 70% at 6 years and when considering the adherence to the 3 associated treatments, corresponding to the optimal preventive therapeutic strategy, adherence was about 70% and it did not decrease between 3 and 6 years. These results are in line with previous studies reporting good adherence within 2 years of stroke based on self-declaration and on the medicoadministrative database using medication possession ratio (MPR >0.8) [21, 23, 24]. Eventually, only 33% of included patients (respectively 70/210 and 53/163) were adherent to the 3 recommended therapeutic classes; that is, combining non-use and non-adherence at 3 and 6 years, 2 out of 3 of patients were not optimally treated to prevent stroke recurrence.…”

Section: Discussionsupporting

confidence: 82%

“…Previous studies have mainly focused on the persistence of preventive treatment during the 2 years following stroke [13, 14, 21, 25-27]. Three months after discharge, about 65% of patients discontinued at least one secondary preventive treatment [13, 26].…”

Section: Discussionmentioning

confidence: 99%

Secondary Prevention Three and Six Years after Stroke Using the French National Insurance Healthcare System Database

et al. 2018

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Background: Secondary prevention is inadequate in the first 2 years after stroke but what happens after that is less documented. The aim of this study was to assess the use and the adherence to preventive drugs 3 and 6 years after experiencing a transient ischemic attack (TIA) or an ischemic stroke (IS). Methods: The population study was from the AVC69 cohort (IS or TIA admitted in an emergency or stroke unit in the Rhône area, France, for an IS or a TIA during a 7-month period). Medication use was defined as ≥1 purchase during the studied year and adherence as Continuous Measure of Medication Acquisition ≥0.8 using the French medical insurance health care funding database. Results: The study population consisted of 210 patients at 3 years and 163 patients at 6 years. Medication use at 3 and 6 years was, respectively, 80.9 and 79.8% for antithrombotics, 69.1 and 66.3% for antihypertensives, 60.5 and 55.2% for statins and 48.6 and 46.6% for optimal treatment defined as the treatment achieved by the use of the 3 drugs. Adherence to each class was good at 3 years and tends to decrease at 6 years. Conclusions: More than one patient out of 2 do not use the optimal preventive treatment.

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“…However, patients' adherence to long-term treatments is quite low [3]. Concerning stroke, medication adherence can vary from 45 to 90% [4,5,6,7,8,9]. It has been proven that poor adherence results in poor treatment outcomes [7,10,11].…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators for Medication Adherence in Stroke Patients: A Qualitative Study Conducted in French Neurological Rehabilitation Units

Bauler¹,

Jacquin-Courtois²,

Haesebaert³

et al. 2014

Eur Neurol

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Objective: To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. Method: A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. Results: Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of overmedication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. Conclusion: This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.

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Impact of persistence with antiplatelet therapy on recurrent ischemic stroke and predictors of nonpersistence among ischemic stroke survivors

Cited by 37 publications

References 18 publications

Discontinuation of Antiplatelet Treatment and Risk of Recurrent Stroke and All-Cause Death: A Cohort Study

Discontinuation of Antiplatelet Treatment and Risk of Recurrent Stroke and All-Cause Death: A Cohort Study

Secondary Prevention Three and Six Years after Stroke Using the French National Insurance Healthcare System Database

Barriers and Facilitators for Medication Adherence in Stroke Patients: A Qualitative Study Conducted in French Neurological Rehabilitation Units

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