Low-Dose Aspirin Therapy for Cardiovascular Prevention Quantification and Consequences of Poor Compliance or Discontinuation

被引:56
作者
Herlitz, Johan [1 ]
Toth, Peter P. [2 ,3 ]
Naesdal, Jorgen [4 ]
机构
[1] Sahlgrens Univ Hosp, Gothenburg, Sweden
[2] Sterling Rock Falls Clin, Sterling, IL USA
[3] Univ Illinois, Coll Med, Peoria, IL 61656 USA
[4] AstraZeneca R&D, Molndal, Sweden
关键词
ACUTE CORONARY SYNDROMES; PROTON PUMP INHIBITORS; LONG-TERM ADHERENCE; RISK-FACTOR; MYOCARDIAL-INFARCTION; SECONDARY PREVENTION; GASTRODUODENAL ULCERS; MEDICATION ADHERENCE; ANTIPLATELET AGENTS; STROKE PREVENTION;
D O I
10.2165/11318440-000000000-00000
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 >144800 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.
引用
收藏
页码:125 / 141
页数:17
相关论文
共 91 条
[1]   Medication adherence and racial differences in AlC control [J].
Adams, Alyce S. ;
Trinacty, Connie Mah ;
Zhang, Fang ;
Kleinman, Ken ;
Grant, Mchard W. ;
Meigs, James B. ;
Solimerai, Stephen B. ;
Ross-Degnan, Dennis .
DIABETES CARE, 2008, 31 (05) :916-921
[2]   Prothrombotic and Hemorrhagic Effects of Aspirin [J].
Aguejouf, Omar ;
Eizayaga, Francisco ;
Desplat, Vanessa ;
Belon, Philippe ;
Doutremepuich, Christian .
CLINICAL AND APPLIED THROMBOSIS-HEMOSTASIS, 2009, 15 (05) :523-528
[3]   Aspirin use among US adults - Behavioral risk factor surveillance system [J].
Ajani, UA ;
Ford, ES ;
Greenland, KJ ;
Giles, WH ;
Mokdad, AH .
AMERICAN JOURNAL OF PREVENTIVE MEDICINE, 2006, 30 (01) :74-77
[4]   COLLABORATIVE OVERVIEW OF RANDOMIZED TRIALS OF ANTIPLATELET THERAPY .1. PREVENTION OF DEATH, MYOCARDIAL-INFARCTION, AND STROKE BY PROLONGED ANTIPLATELET THERAPY IN VARIOUS CATEGORIES OF PATIENTS [J].
ALTMAN, R ;
CARRERAS, L ;
DIAZ, R ;
FIGUEROA, E ;
PAOLASSO, E ;
PARODI, JC ;
CADE, JF ;
DONNAN, G ;
EADIE, MJ ;
GAVAGHAN, TP ;
OSULLIVAN, EF ;
PARKIN, D ;
RENNY, JTG ;
SILAGY, C ;
VINAZZER, H ;
ZEKERT, F ;
ADRIAENSEN, H ;
BERTRANDHARDY, JM ;
BRAN, M ;
DAVID, JL ;
DRICOT, J ;
LAVENNEPARDONGE, E ;
LIMET, R ;
LOWENTHAL, A ;
MORIAU, M ;
SCHAPIRA, S ;
SMETS, P ;
SYMOENS, J ;
VERHAEGHE, R ;
VERSTRAETE, M ;
ATALLAH, A ;
BARNETT, H ;
BATISTA, R ;
BLAKELY, J ;
CAIRNS, JA ;
COTE, R ;
CROUCH, J ;
EVANS, G ;
FINDLAY, JM ;
GENT, M ;
LANGLOIS, Y ;
LECLERC, J ;
NORRIS, J ;
PINEO, GF ;
POWERS, PJ ;
ROBERTS, R ;
SCHWARTZ, L ;
SICURELLA, J ;
TAYLOR, W ;
THEROUX, P .
BMJ-BRITISH MEDICAL JOURNAL, 1994, 308 (6921) :81-100
[5]  
Aubert RE, 2008, CIRCULATION, V118, pS815
[6]   Discontinuing chronic aspirin therapy: Another risk factor for stroke? [J].
Bachman, DS .
ANNALS OF NEUROLOGY, 2002, 51 (01) :137-138
[7]  
Baigent C, 2002, BMJ-BRIT MED J, V324, P71, DOI 10.1136/bmj.324.7329.71
[8]   Fixed-dose combinations improve medication compliance: A meta-analysis [J].
Bangalore, Sripal ;
Kamalakkannan, Gayathri ;
Parkar, Sanobar ;
Messerli, Franz H. .
AMERICAN JOURNAL OF MEDICINE, 2007, 120 (08) :713-719
[9]   Abnormally high platelet activity after discontinuation of acetylsalicylic acid treatment [J].
Beving, H ;
Zhao, C ;
Albage, A ;
Ivert, T .
BLOOD COAGULATION & FIBRINOLYSIS, 1996, 7 (01) :80-84
[10]  
Bhala N, 2010, LANCET, V375, P28, DOI 10.1016/S0140-6736(09)62184-X