Wawruch Martin, Zatko Dusan, Wimmer Gejza, Luha Jan, Wimmerova Sona, Kukumberg Peter, Murin Jan, Hloska Adam, Tesar Tomas, Shah Rashmi
Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08, Bratislava, Slovakia.
General Health Insurance Company, Panónska cesta 2, 851 04, Bratislava, Slovakia.
Aging Clin Exp Res. 2017 Dec;29(6):1121-1127. doi: 10.1007/s40520-017-0745-4. Epub 2017 Mar 11.
Antiplatelet therapy following a transient ischemic attack (TIA) constitutes an important secondary prevention measure.
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.
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.
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).
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.
短暂性脑缺血发作（TIA）后的抗血小板治疗是一项重要的二级预防措施。
本研究旨在评估老年TIA患者抗血小板治疗的不持续性发展情况，并确定随访期间与不持续性概率相关的患者相关特征。
研究队列（n = 854）选自斯洛伐克共和国最大的健康保险提供商的数据库。纳入2010年1月1日至2010年12月31日期间因TIA诊断开始使用抗血小板药物的≥65岁患者。从与TIA诊断相关的首次抗血小板药物处方日期起，对每位患者进行3年随访。抗血小板药物处方至少有6个月治疗间隔的患者被定义为“不持续用药者”。在Cox比例风险模型中确定预测不持续性的因素。
随访期末，345例（40.4%）患者抗血小板药物治疗不持续。降低患者不持续用药可能性的保护因素为年龄≥75岁[风险比（HR）= 0.75]、多重用药（同时使用≥6种药物）（HR = 0.79）、动脉高血压（HR = 0.68）、糖尿病（HR = 0.74）、高胆固醇血症（HR = 0.75）以及随访期间更换抗血小板药物（HR = 0.73）。
得出结论，TIA后，年龄<75岁或血清胆固醇水平正常、无特定合并症且未多重用药的老年患者可能受益于特殊咨询，以鼓励坚持二级预防用药。
