title: Non-adherence to aspirin in patients undergoing coronary stenting: negative impact of comorbid conditions and implications for clinical management.
abstract: BACKGROUND
  Premature discontinuation of and reduced adherence to antiplatelet therapy have been identified as major risk factors for stent thrombosis and poor prognosis after acute coronary syndrome.
  
  
  OBJECTIVE
  We aimed to identify correlates of non-adherence to aspirin among patients who had undergone coronary stenting.
  
  
  METHODS
  We prospectively included all patients who had undergone coronary stenting in our institution. Response to aspirin was assessed during the hospital phase with arachidonic acid-induced platelet aggregation (AA-Ag) and only good responders to aspirin (AA-Ag<30%) were included in the study for longitudinal assessment (n=308). Response to aspirin was reassessed 1 month after hospital discharge and non-responders received a directly observed intake of aspirin to exclude any biological non-response due to bioavailability problems. After excluding patients with such problems, response to aspirin based on platelet function testing was used to estimate non-adherence to aspirin after coronary stenting. A logistic regression model was used to identify predictors of non-adherence.
  
  
  RESULTS
  Non-adherence to aspirin concerned 14% of the study sample (n=43). After adjustment for age, those who reported the highest risk of non-adherence to aspirin were migrants (odds ratio [95% confidence interval], 8.3 [3.5-19.8], followed by patients receiving treatment for diabetes (4.5 [1.9-10.9]). Smokers had a threefold risk of non-adherence (3.1 [1.4-6.9]).
  
  
  CONCLUSIONS
  Non-adherence to aspirin is relatively frequent in populations at high risk of cardiovascular events. Appropriate case management and special interventions targeting these groups need to be implemented to avoid fatal events and assure long-term adherence to treatment.
authors.affiliation: Department of Cardiology, CHU Timone, Marseille, France. thomascuisset@voila.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Jacques
authors.initials: J
authors.lastname: Quilici
authors.forename: Lionel
authors.initials: L
authors.lastname: Fugon
authors.forename: William
authors.initials: W
authors.lastname: Cohen
authors.forename: Perrine
authors.initials: P
authors.lastname: Roux
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Gaborit
authors.forename: Laurent
authors.initials: L
authors.lastname: Molines
authors.forename: Laurent
authors.initials: L
authors.lastname: Fourcade
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bonnet
authors.forename: Patrizia
authors.initials: P
authors.lastname: Carrieri
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001241:Aspirin / Q000627:therapeutic use*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin