Østergaard Kamilla, Madsen Charlotte, Liu Marie-Louise, Bak Søren, Hallas Jesper, Gaist David
Department of Neurology, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark.
Eur J Clin Pharmacol. 2014 Feb;70(2):241-8. doi: 10.1007/s00228-013-1609-2. Epub 2013 Nov 19.
To determine the degree of long-term non-persistence to antiplatelet drugs in patients with transient ischaemic attack (TIA) and identify determinants of this drug-use pattern.
We used community-based prescription registry data to determine antiplatelet drug use in TIA patients presenting to a Danish neurology department in the period 2006-2010. Non-persistence was defined as failure to present a prescription for antiplatelet drugs within 180 days after the dosage of a previous prescription had run out. We used Cox regression to calculate the hazard ratio (HR) for non-persistence and the corresponding 95 % confidence interval (CI) by potential determinants, including a stroke risk score (ABCD2 score). Adherence during follow-up [80 % medication possession ratio (MPR80)] was calculated for antiplatelets, statins and antihypertensive drugs.
The cohort comprised 594 (84 % evaluated as in-patients) TIA patients. During follow-up (median 1.7 years, interquartile range 0.9-3.0 years), 140 (23.6 %) patients became non-persistent. Non-persistence was associated with younger age (<55 years: HR 1.9, 95 % CI 1.3-2.8) and delay between TIA onset and neurological evaluation (7+ days: HR 2.0, 95 % CI 1.0-4.1). Among admitted patients, a higher ABCD2 score (4+: HR 1.3, 95 % CI 0.8-2.1) was also indicative of non-persistence. Non-persistent users were less adherent to other preventive medication (MPR80: statins 31.8 vs. 75.3 %, p value < 0.001; antihypertensives 64.3 vs. 79.5 %, p value: 0.02) than persistent users.
Long-term antiplatelet non-persistence was most pronounced in patients of younger age, those with delayed evaluation of symptoms and those at greater risk of stroke. It was also associated with a lower adherence to preventive medication in general.
确定短暂性脑缺血发作（TIA）患者长期不坚持服用抗血小板药物的程度，并找出这种用药模式的决定因素。
我们利用基于社区的处方登记数据，确定2006年至2010年期间到丹麦某神经内科就诊的TIA患者的抗血小板药物使用情况。不坚持用药被定义为在前一次处方剂量用完后的180天内未开具抗血小板药物处方。我们使用Cox回归计算不坚持用药的风险比（HR）以及由潜在决定因素（包括卒中风险评分（ABCD2评分））得出的相应95%置信区间（CI）。计算了随访期间抗血小板药物、他汀类药物和抗高血压药物的依从性[80%药物持有率（MPR80）]。
该队列包括594例TIA患者（84%被评估为住院患者）。在随访期间（中位时间1.7年，四分位间距0.9 - 3.0年），140例（23.6%）患者不再坚持用药。不坚持用药与年龄较轻（<55岁：HR 1.9，95%CI 1.3 - 2.8）以及TIA发作与神经学评估之间的延迟（7天以上：HR 2.0，95%CI 1.0 - 4.1）有关。在住院患者中，较高的ABCD2评分（4分及以上：HR 1.3，95%CI 0.8 - 2.1）也表明不坚持用药。与坚持用药的患者相比，不坚持用药的患者对其他预防性药物的依从性较低（MPR80：他汀类药物31.8%对75.3%，p值<0.001；抗高血压药物64.3%对79.5%，p值：0.02）。
长期不坚持服用抗血小板药物在年龄较轻、症状评估延迟以及卒中风险较高的患者中最为明显。这通常也与对预防性药物的较低依从性有关。
