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Compliance with antiplatelet therapy in patients with ischemic cerebrovascular disease. Assessment by platelet
1Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
Insights
Patient compliance with antiplatelet therapy is crucial for preventing stroke. This study found that 10% of outpatients were non-compliant, highlighting the need for regular monitoring and patient guidance to ensure effective treatment.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Antiplatelet therapy is vital for preventing transient ischemic attacks and cerebral thrombosis.
- Long-term antiplatelet agent administration necessitates a focus on patient compliance.
- Assessing patient adherence is critical for the efficacy of antiplatelet treatments.
Purpose of the Study:
- To determine patient compliance during antiplatelet therapy.
- To establish optimal conditions for platelet aggregation testing to assess compliance.
- To evaluate the impact of noncompliance on antiplatelet treatment effectiveness.
Main Methods:
- Platelet aggregation tests were conducted using adenosine diphosphate (ADP) and collagen.
- Optimal concentrations of aggregation-inducing agents were determined for aspirin and ticlopidine users.
- Compliance was assessed in 159 outpatients and 79 inpatients, with interviews used to verify noncompliance.
Main Results:
- Optimal conditions were identified as 2 micrograms/mL collagen for aspirin (81 mg/d) and 2 mumol/L ADP for ticlopidine (200 mg/d).
- Noncompliance was identified in 17 out of 159 outpatients (10%), leading to inadequate platelet aggregation reduction.
- The study demonstrated a direct link between noncompliance and insufficient antiplatelet effect.
Conclusions:
- Monitoring patient compliance is essential for outpatients receiving antiplatelet therapy.
- Platelet aggregation testing is the preferred method for assessing compliance.
- When direct testing is not feasible, periodic compliance assessments and patient education are necessary.
Background And Purpose:
Antiplatelet therapy is currently one of the methods for preventing transient ischemic attacks and cerebral thrombosis. Because antiplatelet agents are generally administered on a long-term basis, patient compliance is an important factor. The purpose of this study was to determine the compliance of patients during antiplatelet therapy by testing platelet aggregation.
Methods:
To establish the conditions for measuring platelet aggregation, the platelet aggregation test was performed in patients taking 81 mg/d aspirin or 200 mg/d ticlopidine at the following final concentrations of aggregation-inducing agents: 0.5, 1, 2, and 4 mumol/L ADP and 0.5 and 2 micrograms/mL collagen. The optimum measurement conditions for assessing patient compliance were determined. Under the conditions determined in the first study, platelet aggregation was assessed, and the effects of treatment were studied in 159 outpatients and 79 inpatients undergoing antiplatelet therapy. If the antiplatelet effect was insufficient, compliance was checked by interview.
Results:
The agents used and the final concentrations found to be optimum for assessing platelet aggregation were 2 micrograms/mL collagen for patients taking aspirin 81 mg/day and 2 mumol/L ADP for patients taking ticlopidine 200 mg/d. In 17 (10%) of the 159 outpatients, platelet aggregation was not adequately reduced because of noncompliance with their antiplatelet therapy.
Conclusions:
This study indicated that monitoring of compliance is important for outpatients on antiplatelet therapy. It is best if platelet aggregation can be checked, but when this is impossible it is necessary to assess compliance periodically and provide patient guidance.