title: Non-persistence with antiplatelet therapy in elderly patients after a transient ischemic attack.
abstract: BACKGROUND
  Antiplatelet therapy following a transient ischemic attack (TIA) constitutes an important secondary prevention measure.
  
  
  OBJECTIVE
  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 <75 years or those with normal serum cholesterol levels, without certain comorbid conditions and polypharmacy may benefit from special counselling to encourage persistence with secondary preventive medication.
authors.affiliation: Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, 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, Panónska cesta 2, 851 04, Bratislava, Slovakia.
authors.forename: Dusan
authors.initials: D
authors.lastname: Zatko
authors.affiliation: Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08, Bratislava, Slovakia.
authors.forename: Gejza
authors.initials: G
authors.lastname: Wimmer
authors.affiliation: Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08, Bratislava, Slovakia.
authors.forename: Jan
authors.initials: J
authors.lastname: Luha
authors.affiliation: Department of Biophysics, Informatics and Biostatistics, Faculty of Public Health, Slovak Medical University, Limbová 12, 833 03, Bratislava, Slovakia.
authors.forename: Sona
authors.initials: S
authors.lastname: Wimmerova
authors.affiliation: 2nd Department of Neurology, Faculty of Medicine, Comenius University, Limbová 5, 833 05, Bratislava, Slovakia.
authors.forename: Peter
authors.initials: P
authors.lastname: Kukumberg
authors.affiliation: 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Mickiewiczova 13, 813 69, Bratislava, Slovakia.
authors.forename: Jan
authors.initials: J
authors.lastname: Murin
authors.affiliation: Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University, Mala Hora 11161, 036 01, Martin, Slovakia.
authors.forename: Adam
authors.initials: A
authors.lastname: Hloska
authors.affiliation: Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Kalinciakova 8, 832 32, Bratislava, Slovakia.
authors.forename: Tomas
authors.initials: T
authors.lastname: Tesar
authors.affiliation: Rashmi Shah, Pharmaceutical Consultant, 8 Birchdale, Gerrards Cross, Bucks, SL9 7JA, UK.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019338:Polypharmacy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055502:Secondary Prevention; D018154:Slovakia; D020521:Stroke / Q000517:prevention & control; D016903:Drug Monitoring
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Antiplatelet; Arterial hypertension; Diabetes mellitus; Persistence; Polypharmacy; Transient ischemic attack