Evaluating Antiplatelet Compliance in Recurrent Stroke Patients

Download Article

DOI: 10.21522/TIJPH.2013.SE.24.05.Art021

Authors : Samuel M, Sava Nanda Gopal, Saranya Palanasamy, Kanimozhi David, Kannan Rajendran

Abstract:

Stroke is a leading cause of death and disability worldwide, with recurrent strokes posing a significant challenge in healthcare. Antiplatelet therapy, including agents such as aspirin and clopidogrel, is fundamental in reducing the risk of recurrent ischemic events. The present study aims to evaluate the current literature on adherence to antiplatelet therapy in recurrent stroke patients and also to identify key factors influencing adherence, explore innovative strategies to improve adherence rates and highlight areas for future research. In conclusion, our study highlights the importance of medication-related factors in the management of recurrent stroke patients. Optimizing antiplatelet therapy regimens, addressing barriers to medication adherence, and mitigating adverse events are crucial steps toward improving secondary stroke prevention strategies and enhancing patient outcomes. However, the effectiveness of these therapies is highly dependent on patient adherence, which remains suboptimal, leading to increased risks of recurrent strokes and other cardiovascular events.

References:

[1].   Kernan, W. N., 2015. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association (vol 45, pg 2160, 2014). Stroke, 46(2), E54-E54. doi:10.1161/STR.0000000000000024.

[2].   Osterberg, L., Blaschke, T., 2005. Adherence to medication. New England journal of medicine, 353(5), 487-497. doi:10.1056/NEJMra050100.

[3].   Algra, A., 2007. Medium intensity oral anticoagulants versus aspirin after cerebral ischaemia of arterial origin (ESPRIT): a randomised controlled trial. The Lancet Neurology, 6(2), 115-124. doi:10.1016/S1474-4422(06)70685-8.

[4].   Lowres, N., Giskes, K., Hespe, C., Freedman, B., 2019. Reducing stroke risk in atrial fibrillation: adherence to guidelines has improved, but patient persistence with anticoagulant therapy remains suboptimal. Korean Circulation Journal, 49(10), 883-907. doi:10.4070/kcj.2019.0234.

[5].   Pandya, E. Y., Bajorek, B., 2017. Factors affecting patients’ perception on, and adherence to, anticoagulant therapy: anticipating the role of direct oral anticoagulants. The Patient-Patient-Centered Outcomes Research, 10, 163-185. doi:10.1007/s40271-016-0180-1.

[6].   Ruksakulpiwat, S., Benjasirisan, C., Ding, K., Phianhasin, L., Thorngthip, S., Ajibade, A. D., Voss, J. G., 2023. Utilizing social determinants of health model to understand barriers to medication adherence in patients with ischemic stroke: a systematic review. Patient preference and adherence, 2161-2174.  doi:10.2147/PPA.S420059.

[7].   Sabouret, P., Savage, M. P., Fischman, D., Costa, F., 2021. Complexity of antiplatelet therapy in coronary artery disease patients. American Journal of Cardiovascular Drugs, 21(1), 21-34. doi:10.1007/s40256-020-00414-0.

[8].   Diener, H. C., Weimar, C., Weber, R., 2010. Antiplatelet therapy in secondary stroke prevention–state of the art. Journal of Cellular and Molecular Medicine, 14(11), 2552-2560. doi:10.1111/j.1582-4934.2010.01163.x.

[9].   Bushnell, C., McCullough, L. D., Awad, I. A., Chireau, M. V., Fedder, W. N., Furie, K. L., Walters, M. R., 2014. Guidelines for the prevention of stroke in women: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(5), 1545-1588. doi:10.1161/01.str.0000442009.06663.48.

[10].  De Schryver, E. L. L. M., van Gijn, J., Kappelle, L. J., Koudstaal, P. J., Algra, A., 2005. Non–adherence to aspirin or oral anticoagulants in secondary prevention after ischaemic stroke. Journal of neurology, 252, 1316-1321. doi:10.1007/s00415-005-0858-0.

[11].  Kulkarni, S. P., Alexander, K. P., Lytle, B., Heiss, G., Peterson, E. D.., 2006. Long-term adherence with cardiovascular drug regimens. American heart journal, 151(1), 185-191. doi:10.1016/j.ahj.2005.02.038.

[12].  Passacquale, G., Sharma, P., Perera, D., Ferro, A. 2022. Antiplatelet therapy in cardiovascular disease: Current status and future directions. British Journal of Clinical Pharmacology, 88(6), 2686-2699. doi:10.1111/bcp.15221.

[13].  Hilkens, N. A., Algra, A., Diener, H. C., Bath, P. M., Csiba, L., Hacke, W., Greving, J. P., 2021. Balancing benefits and risks of long-term antiplatelet therapy in noncardioembolic transient ischemic attack or stroke. Stroke. doi:10.1161/STROKEAHA.120.031755.