Abstract 124: Impact Of Adherence With Antiplatelet Monotherapy On The Mortality After Ischemic Stroke: A Nationwide Multicenter Follow-up Study

Introduction: Antiplatelets are the most important drugs to prevent ischemic stroke. These drugs are prescribed for nearly life long period. However, few studies have elaborated on the significance of adherence with antiplatelet monotherapy in ischemic stroke. Methods: We enrolled 36,128 patients with ischemic stroke from Jan 2008 through Dec 2011 from 40 hospitals which were participated in a nationwide research project in Korea. The whole drug information was obtained from the Health Insurance Review and Assessment Service in Korea. Among them, 8,299 patients had taken antiplatelet monotherapy over 6 months with one of the most popular antiplatelet drugs (aspirin, clopidogrel or cilostazol). The adherence with antiplatelet monotherpay was defined as % adherence = (n of days’ supply) / (actual n of days to refill) х 100. Nonadherence was defined as < 80% adherence. The mortality and drug information were censored on 31 Dec 2012. Results: From 8,299 patients using a single antiplatelet drug over 6 months, 1056 (12.7%) patients were included in nonadherence group. The factors related to nonadherence were severe neurological deficits and the atherosclerotic stroke subtype. Compared with the good adherence group, the adjusted hazard ratio (HR) of the nonadherence group for all-cause mortality was 1.49 (95% CI, 1.28-1.73), after controlling age, stroke severity, stroke subtype, and the presence of hypertension, diabetes, hyperlipidemia, and smoking. In subgroup analyses, the adjusted HRs for mortality after ischemic stroke were increased in the aspirin or clopidogrel monotherapy group respectively, compared with good adherence group (HR and 95% CI in nonadherence with aspirin, 1.22 and 1.01-1.46; HR and 95% CI in nonadherence with clopidogrel, 2.07 and 1.53-2.82). Conclusion: Our study demonstrated that nonadherence with antiplatelet monotherapy is an independent predictor of all-cause death after ischemic stroke from nationwide multicenter follow-up study. ![][1] [1]: /embed/graphic-1.gif