title: Factors Influencing Non-Persistence with Antiplatelet Medications in Elderly Patients After Ischaemic Stroke.
abstract: OBJECTIVE
  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.
authors.affiliation: Faculty of Medicine, Institute of Pharmacology and Clinical Pharmacology, Comenius University, Sasinkova, 4, 811 08, Bratislava, Slovakia. martin.wawruch@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Wawruch
authors.affiliation: General Health Insurance Company, Bratislava, Slovakia.
authors.forename: Dusan
authors.initials: D
authors.lastname: Zatko
authors.affiliation: Faculty of Medicine, Institute of Pharmacology and Clinical Pharmacology, Comenius University, Sasinkova, 4, 811 08, Bratislava, Slovakia.
authors.forename: Gejza
authors.initials: G
authors.lastname: Wimmer
authors.affiliation: Department of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
authors.forename: Jan
authors.initials: J
authors.lastname: Luha
authors.affiliation: Faculty of Medicine, Institute of Pharmacology and Clinical Pharmacology, Comenius University, Sasinkova, 4, 811 08, Bratislava, Slovakia.
authors.forename: Lenka
authors.initials: L
authors.lastname: Kuzelova
authors.affiliation: 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
authors.forename: Peter
authors.initials: P
authors.lastname: Kukumberg
authors.affiliation: 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
authors.forename: Jan
authors.initials: J
authors.lastname: Murin
authors.affiliation: Ministry of Health of the Slovak Republic, Bratislava, Slovakia.|Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
authors.forename: Adam
authors.initials: A
authors.lastname: Hloska
authors.affiliation: Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia.
authors.forename: Tomas
authors.initials: T
authors.lastname: Tesar
authors.affiliation: Faculty of Medicine, Institute of Pharmacology and Clinical Pharmacology, Comenius University, Sasinkova, 4, 811 08, Bratislava, Slovakia.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Kallay
authors.affiliation: , Gerrards Cross, UK.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D055502:Secondary Prevention; D018154:Slovakia; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control*; D016903:Drug Monitoring
chemical_list: D010975:Platelet Aggregation Inhibitors