Factors Influencing Non-Persistence with Antiplatelet Medications in Elderly Patients After Ischaemic Stroke

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. 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 a parts per thousand yen65 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. 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 a parts per thousand yen75 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). 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.