Reinitiation and Subsequent Discontinuation of Antiplatelet Treatment in Nonpersistent Older Patients with Peripheral Arterial Disease
Abstract
:1. Introduction
2. Materials and Methods
2.1. Database and Study Population
2.2. Analysis of Reinitiation and Subsequent Discontinuation after Reinitiation
2.3. Factors Associated with Reinitiation and Discontinuation among Reinitiators
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Factor | Analysis of Reinitiation (n = 3032) | Analysis of Discontinuation Among Reinitiators (n = 2006) | ||||
---|---|---|---|---|---|---|
Without Reinitiation (n = 1026) | With Reinitiation (n = 2006) | p | Persistent (n = 928) | Non-Persistent (n = 1078) | p | |
Socio-demographic characteristics | ||||||
Age | 74.4 ± 6.0 | 73.3 ± 6.0 | <0.001 * | 73.5 ± 6.1 | 73.1 ± 5.9 | 0.231 * |
Female sex | 617 (60.1) | 1255 (62.6) | 0.193 | 567 (61.1) | 688 (63.8) | 0.209 |
University education | 84 (8.2) | 160 (8.0) | 0.840 | 63 (6.8) | 97 (9.0) | 0.069 |
Employed patients | 55 (5.4) | 135 (6.7) | 0.141 | 67 (7.2) | 68 (6.3) | 0.416 |
History of cardiovascular events a | ||||||
History of ischemic stroke | 334 (32.6) | 367 (18.3) | <0.001 | 266 (28.7) | 220 (20.4) | <0.001 |
History of TIA | 136 (13.3) | 207 (10.3) | 0.016 | 137 (14.8) | 127 (11.8) | 0.049 |
History of MI | 136 (13.3) | 127 (6.3) | <0.001 | 97 (10.5) | 95 (8.8) | 0.213 |
Cardiovascular events during non-persistence/period of reinitiation | ||||||
Ischemic stroke | 88 (8.6) | 119 (5.9) | 0.006 | 102 (11.0) | 40 (3.7) | <0.001 |
TIA | 36 (3.5) | 57 (2.8) | 0.313 | 39 (4.2) | 20 (1.9) | 0.002 |
MI | 38 (3.7) | 65 (3.2) | 0.505 | 55 (5.9) | 24 (2.2) | <0.001 |
Comorbid conditions | ||||||
Number of comorbid conditions | 2.8 ± 1.6 | 2.6 ± 1.5 | <0.001 * | 2.5 ± 1.5 | 2.6 ± 1.5 | 0.177 * |
Arterial hypertension | 835 (81.4) | 1498 (74.7) | <0.001 | 697 (75.1) | 801 (74.3) | 0.680 |
Chronic heart failure | 85 (8.3) | 91 (4.5) | <0.001 | 30 (3.2) | 61 (5.7) | 0.009 |
Atrial fibrillation | 219 (21.3) | 169 (8.4) | <0.001 | 70 (7.5) | 99 (9.2) | 0.187 |
Diabetes mellitus | 397 (38.7) | 730 (36.4) | 0.214 | 367 (39.5) | 363 (33.7) | 0.006 |
Hypercholesterolemia | 398 (38.8) | 818 (40.8) | 0.291 | 366 (39.4) | 452 (41.9) | 0.258 |
Dementia | 67 (6.5) | 104 (5.2) | 0.129 | 51 (5.5) | 53 (4.9) | 0.560 |
Depression | 122 (11.9) | 215 (10.7) | 0.331 | 93 (10.0) | 122 (11.3) | 0.350 |
Anxiety disorders | 318 (31.0) | 622 (31.0) | 0.994 | 271 (29.2) | 351 (32.6) | 0.105 |
Parkinson’s disease | 47 (4.6) | 71 (3.5) | 0.161 | 36 (3.9) | 35 (3.2) | 0.445 |
Epilepsy | 21 (2.0) | 46 (2.3) | 0.662 | 24 (2.6) | 22 (2.0) | 0.416 |
Bronchial asthma/COPD | 222 (21.6) | 487 (24.3) | 0.104 | 211 (22.7) | 276 (25.6) | 0.136 |
Antiplatelet agent related characteristics | ||||||
Antiplatelet agent b | ||||||
Aspirin | 672 (65.5) | 1596 (79.6) | <0.001 | 697 (75.2) | 848 (78.7) | <0.001 |
Clopidogrel | 307 (29.9) | 376 (18.7) | 149 (16.1) | 154 (14.3) | ||
Ticlopidine | 25 (2.7) | 45 (4.2) | ||||
Aspirin + Clopidogrel | 47 (4.6) | 34 (1.7) | 56 (6.0) | 31 (2.9) | ||
Patient’s co-payment (EUR) c | 1.5 ± 1.0 | 1.2 ± 0.9 | <0.001 * | 1.4 ± 1.0 | 1.3 ± 0.9 | <0.001 * |
New antiplatelet agent user d | 146 (14.2) | 431 (21.5) | <0.001 | 183 (19.7) | 248 (23.0) | 0.074 |
General practitioner as index prescriber | 712 (69.4) | 1340 (66.8) | 0.148 | 642 (69.2) | 698 (64.7) | 0.036 |
Cardiovascular co-medication | ||||||
Number of medications | 8.2 ± 2.6 | 7.5 ± 2.9 | <0.001 * | 7.6 ± 2.8 | 7.5 ± 2.9 | 0.514 * |
Number of CV medications | 5.2 ± 2.4 | 4.5 ± 2.1 | <0.001 * | 4.5 ± 2.1 | 4.6 ± 2.2 | 0.727 |
Anticoagulants | 256 (25.0) | 361 (18.0) | <0.001 | 155 (16.7) | 206 (19.1) | 0.162 |
Cardiac glycosides | 95 (9.3) | 71 (3.5) | <0.001 | 32 (3.4) | 39 (3.6) | 0.838 |
Antiarrhythmic agents | 127 (12.4) | 111 (5.5) | <0.001 | 41 (4.4) | 70 (6.5) | 0.043 |
Beta-blockers | 214 (20.9) | 334 (16.7) | 0.004 | 145 (15.6) | 189 (17.5) | 0.253 |
Thiazide diuretics | 248 (24.2) | 430 (21.4) | 0.087 | 204 (22.0) | 226 (21.0) | 0.580 |
Loop diuretics | 232 (22.6) | 290 (14.5) | <0.001 | 125 (13.5) | 165 (15.3) | 0.244 |
Mineralocorticoid receptor antagonists | 79 (7.7) | 68 (3.4) | <0.001 | 35 (3.8) | 33 (3.1) | 0.381 |
Calcium channel blockers | 313 (30.5) | 625 (31.2) | 0.714 | 299 (32.2) | 326 (30.2) | 0.340 |
RAAS inhibitors | 864 (84.2) | 1607 (80.1) | 0.006 | 739 (79.6) | 868 (80.5) | 0.620 |
Statin | 754 (73.5) | 1397 (69.6) | 0.027 | 656 (70.7) | 741 (68.7) | 0.343 |
Lipid lowering agents other than statins e | 100 (9.7) | 206 (10.3) | 0.651 | 96 (10.3) | 110 (10.2) | 0.918 |
Duration of persistence/non-persistence (months) f | 26.4 ± 15.7 | 13.9 ± 12.8 | <0.001 * | 16.7 ± 13.5 | 13.6 ± 8.9 | 0.052 * |
Factor | Analysis of Reinitiation (n = 3032) | Analysis of Discontinuation Among Reinitiators (n = 2006) |
---|---|---|
HR (95% CI) | HR (95% CI) | |
Socio-demographic characteristics | ||
Age | 0.99 (0.98–1.00) | 0.98 (0.97–0.99) |
Female sex | 1.05 (0.95–1.16) | 1.11 (0.96–1.28) |
University education | 1.00 (0.85–1.19) | 1.41 (1.12–1.77) |
Employed patients | 1.02 (0.84–1.23) | 0.86 (0.66–1.12) |
History of cardiovascular events a | ||
History of ischemic stroke | 0.82 (0.72–0.93) | 0.82 (0.70–0.96) |
History of TIA | 1.06 (0.91–1.24) | 0.95 (0.78–1.16) |
History of MI | 0.85 (0.70–1.03) | 1.02 (0.81–1.29) |
Cardiovascular events during non-persistence/period of reinitiation | ||
Ischemic stroke | 1.48 (1.21–1.81) | 0.74 (0.53–1.04) |
TIA | 1.29 (0.98–1.69) | 1.23 (0.77–1.96) |
MI | 1.63 (1.26–2.12) | 1.01 (0.64–1.59) |
Comorbid conditions | ||
Number of comorbid conditions | 0.95 (0.84–1.08) | 1.12 (0.95–1.33) |
Arterial hypertension | 1.06 (0.89–1.27) | 0.86 (0.67–1.10) |
Chronic heart failure | 1.02 (0.79–1.32) | 1.26 (0.90–1.76) |
Atrial fibrillation | 0.67 (0.54–0.84) | 0.90 (0.67–1.20) |
Diabetes mellitus | 0.97 (0.83–1.14) | 0.76 (0.62–0.94) |
Hypercholesterolemia | 1.13 (0.96–1.33) | 0.93 (0.75–1.16) |
Dementia | 0.98 (0.77–1.25) | 0.89 (0.64–1.25) |
Depression | 0.99 (0.81–1.21) | 0.94 (0.72–1.23) |
Anxiety disorders | 1.02 (0.86–1.20) | 0.97 (0.78–1.21) |
Parkinson’s disease | 1.01 (0.77–1.33) | 0.80 (0.54–1.18) |
Epilepsy | 1.34 (0.97–1.86) | 0.79 (0.49–1.27) |
Bronchial asthma/COPD | 1.21 (1.02–1.43) | 0.96 (0.76–1.22) |
Antiplatelet agent related characteristics | ||
Antiplatelet agent b | ||
Aspirin | 1.00 | 1.00 |
Clopidogrel | 0.70 (0.61–0.81) | 1.04 (0.85–1.27) |
Ticlopidine | 1.39 (0.97–1.99) | |
Aspirin + Clopidogrel | 0.54 (0.37–0.79) | 0.67 (0.44–1.02) |
Patient´s co-payment (EUR) c | 1.03 (0.97–1.10) | 0.90 (0.82–0.98) |
New antiplatelet agent user d | 0.93 (0.81–1.06) | 1.12 (0.93–1.34) |
General practitioner as index prescriber | 1.03 (0.93–1.14) | 0.96 (0.83–1.10) |
Cardiovascular co-medication | ||
Number of medications | 1.01 (0.99–1.04) | 0.98 (0.95–1.01) |
Number of CV medications | 1.00 (0.95–1.05) | 1.02 (0.96–1.09) |
Anticoagulants | 1.00 (0.87–1.13) | 1.02 (0.86–1.21) |
Cardiac glycosides | 0.67 (0.51–0.86) | 1.00 (0.70–1.43) |
Antiarrhythmic agents | 0.89 (0.72–1.11) | 1.17 (0.87–1.56) |
Beta-blockers | 0.84 (0.73–0.96) | 1.06 (0.88–1.28) |
Thiazide diuretics | 1.00 (0.88–1.13) | 0.92 (0.78–1.10) |
Loop diuretics | 0.87 (0.75–1.01) | 1.08 (0.88–1.33) |
Mineralocorticoid receptor antagonists | 0.85 (0.66–1.11) | 0.77 (0.52–1.12) |
Calcium channel blockers | 1.11 (0.98–1.25) | 0.87 (0.74–1.03) |
RAAS inhibitors | 0.90 (0.78–1.03) | 1.12 (0.93–1.36) |
Statin | 1.07 (0.96–1.19) | 0.92 (0.79–1.06) |
Lipid lowering agents other than statins e | 0.94 (0.80–1.10) | 0.96 (0.78–1.19) |
Duration of persistence/non-persistence (months) f | 0.99 (0.98–0.99) | 1.00 (0.99–1.01) |
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Wawruch, M.; Murin, J.; Tesar, T.; Paduchova, M.; Petrova, M.; Celovska, D.; Havelkova, B.; Trnka, M.; Aarnio, E. Reinitiation and Subsequent Discontinuation of Antiplatelet Treatment in Nonpersistent Older Patients with Peripheral Arterial Disease. Biomedicines 2021, 9, 1280. https://doi.org/10.3390/biomedicines9091280
Wawruch M, Murin J, Tesar T, Paduchova M, Petrova M, Celovska D, Havelkova B, Trnka M, Aarnio E. Reinitiation and Subsequent Discontinuation of Antiplatelet Treatment in Nonpersistent Older Patients with Peripheral Arterial Disease. Biomedicines. 2021; 9(9):1280. https://doi.org/10.3390/biomedicines9091280
Chicago/Turabian StyleWawruch, Martin, Jan Murin, Tomas Tesar, Martina Paduchova, Miriam Petrova, Denisa Celovska, Beata Havelkova, Michal Trnka, and Emma Aarnio. 2021. "Reinitiation and Subsequent Discontinuation of Antiplatelet Treatment in Nonpersistent Older Patients with Peripheral Arterial Disease" Biomedicines 9, no. 9: 1280. https://doi.org/10.3390/biomedicines9091280