Sahlgrenska University Hospital, Gothenburg, Sweden.
Am J Cardiovasc Drugs. 2010;10(2):125-41. doi: 10.2165/11318440-000000000-00000.
Long-term therapy with low-dose aspirin (acetylsalicylic acid; ASA), 75-325 mg, is highly effective for the secondary prevention of cardiovascular (CV) events. For high-CV-risk patients to attain the full benefits of this therapy, it is important that treatment is continuous and that good compliance is maintained over the long term. We aimed to quantify the level of, and investigate the reasons for, patient-driven non-compliance and treatment discontinuation among patients taking low-dose ASA for the prevention of CV events. We therefore performed a systematic search of the PubMed, Embase, and Cochrane databases using the terms 'aspirin' AND 'patient compliance' OR 'withdrawal', with no restrictions on the start date and up to July 2008. A total of 32 studies, summarizing >144 800 patients, were selected from over 400 results for inclusion. Poor compliance (defined differently among the studies included) with low-dose ASA therapy ranged from approximately 10% to over 50%, and patient-initiated discontinuation of therapy occurred in up to 30% of patients. Common predictors of both non-compliance and treatment discontinuation were lower education level, female sex, or a history of depression, diabetes mellitus, or cigarette smoking. Adverse events were cited as the reason for low-dose ASA discontinuation in almost 50% of patients. The findings of this review suggest that poor compliance is common among patients receiving low-dose ASA therapy, placing them at substantial risk of CV events. By addressing barriers to compliance with low-dose ASA therapy, healthcare professionals can improve CV risk management for such patients.
长期低剂量阿司匹林（乙酰水杨酸；ASA）治疗，剂量为 75-325mg，对心血管（CV）事件的二级预防非常有效。为了使高 CV 风险患者充分受益于这种治疗，重要的是治疗要持续，并且要长期保持良好的依从性。我们旨在量化并研究接受低剂量 ASA 预防 CV 事件的患者停药和不依从的程度及其原因。因此，我们使用“aspirin”和“patient compliance”或“withdrawal”这两个词，在 PubMed、Embase 和 Cochrane 数据库中进行了系统检索，没有对起始日期进行限制，检索时间截至 2008 年 7 月。从 400 多项结果中选择了 32 项研究，这些研究共总结了超过 144800 名患者。低剂量 ASA 治疗的依从性较差（在纳入的研究中定义不同），范围约为 10%至 50%以上，多达 30%的患者自行停止治疗。低教育水平、女性、或有抑郁、糖尿病或吸烟史等常见预测因素与不依从和治疗停药均相关。将近 50%的患者因不良反应而停止低剂量 ASA 治疗。这项综述的结果表明，接受低剂量 ASA 治疗的患者依从性较差很常见，这使他们面临重大 CV 事件风险。通过解决低剂量 ASA 治疗依从性的障碍，医疗保健专业人员可以改善此类患者的 CV 风险管理。
