scholarly journals Reinitiation and Subsequent Discontinuation of Antiplatelet Treatment in Nonpersistent Older Patients with Peripheral Arterial Disease

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1280
Author(s):  
Martin Wawruch ◽  
Jan Murin ◽  
Tomas Tesar ◽  
Martina Paduchova ◽  
Miriam Petrova ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Cox Regression ◽  
Antiplatelet Agents ◽  
Arterial Disease ◽  
University Education ◽  
Chronic Obstructive ◽  
Factors Associated ◽  
Antiplatelet Medication ◽  
Peripheral Arterial

The successful treatment of peripheral arterial disease (PAD) depends on adequate adherence to medications including antiplatelet agents. The aims of this study were (a) to identify the proportion of nonpersistent patients who reinitiated antiplatelet therapy and how many of them discontinued therapy after reinitiation, and (b) to identify patient- and medication-related characteristics associated with the likelihood of reinitiation and discontinuation among reinitiators. The analysis of reinitiation was conducted on 3032 nonpersistent users of antiplatelet agents aged ≥65 years, with PAD newly diagnosed in 2012. Discontinuation (i.e., a treatment gap of ≥6 months without antiplatelet medication prescription) was analysed in 2006 reinitiating patients. To identify factors associated with the likelihood of reinitiation and discontinuation, Cox regression with time-dependent covariates was used. Reinitiation was recorded in 2006 (66.2%) of 3032 patients who had discontinued antiplatelet medication. Among these 2006 reinitiators, 1078 (53.7%) patients discontinued antiplatelet therapy again. Ischemic stroke and myocardial infarction during nonpersistence and bronchial asthma/chronic obstructive pulmonary disease were associated with an increased likelihood of reinitiation. University education was associated with discontinuation among reinitiators. Factors associated with the probability of reinitiation and discontinuation in reinitiators make it possible to identify older PAD patients in whom “stop-starting” behaviour may be expected.

scholarly journals Non-Persistence With Antiplatelet Medications Among Older Patients With Peripheral Arterial Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Martin Wawruch ◽  
Jan Murin ◽  
Tomas Tesar ◽  
Martina Paduchova ◽  
Miriam Petrova ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Cox Regression ◽  
Arterial Disease ◽  
Study Data ◽  
Chronic Obstructive ◽  
Study Cohort ◽  
Antiarrhythmic Agents ◽  
Insurance Company ◽  
Antiplatelet Medication ◽  
Peripheral Arterial

Introduction: Antiplatelet therapy needs to be administered life-long in patients with peripheral arterial disease (PAD). Our study was aimed at 1) the analysis of non-persistence with antiplatelet medication in older PAD patients and 2) identification of patient- and medication-related characteristics associated with non-persistence.Methods: The study data was retrieved from the database of the General Health Insurance Company. The study cohort of 9,178 patients aged ≥ 65 years and treated with antiplatelet medications was selected from 21,433 patients in whom PAD was newly diagnosed between 01/2012 and 12/2012. Patients with a 6 months treatment gap without antiplatelet medication prescription were classified as non-persistent. Characteristics associated with non-persistence were identified using the Cox regression.Results: At the end of the 5 years follow-up, 3,032 (33.0%) patients were non-persistent. Age, history of ischemic stroke or myocardial infarction, clopidogrel or combination of aspirin with clopidogrel used at the index date, higher co-payment, general practitioner as index prescriber and higher overall number of medications were associated with persistence, whereas female sex, atrial fibrillation, anxiety disorders, bronchial asthma/chronic obstructive pulmonary disease, being a new antiplatelet medication user (therapy initiated in association with PAD diagnosis), and use of anticoagulants or antiarrhythmic agents were associated with non-persistence.Conclusion: In patients with an increased probability of non-persistence, an increased attention should be paid to improvement of persistence.

scholarly journals Antiplatelet Therapy in Secondary Prevention in Patients with Ischaemic Peripheral Arterial Disease

2020 ◽  
pp. 1-5
Author(s):  
Pavel Chrbolka ◽  
Zoltán Paluch ◽  
Pavel Chrbolka ◽  
Gergely Pallag
Keyword(s):  
Clinical Trials ◽  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Arterial Disease ◽  
Effective Therapy ◽  
Antiplatelet Drugs ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
Peripheral Arterial

Introduction: Globally, peripheral arterial disease affects almost 200 million individuals at high risk of developing another type of cardiovascular disease with an annual incidence of cardiovascular events and cardiovascular mortality of 4-5% and a risk of acute limb ischaemia and amputation of 5%. All patients with clinical symptomatology of peripheral arterial disease should be treated with statins and antiplatelet drugs. Evidence Acquisition: The authors provide an overview, from the perspective of a clinical pharmacologist, of the pharmacokinetic properties of the antiplatelet agents available, mechanisms of their action, and differences among individual agents in side effects, efficacy and safety as well as a comparison of clinical trials. Evidence Synthesis: In a significant proportion of patients, therapy with clopidogrel is modified, with genetic polymorphism demonstrably preventing effective therapy in a proportion of patients. In cases where an antiplatelet agent other than aspirin is chosen, clopidogrel therapy is rational only if a genetic mutation resulting in ineffective therapy has been ruled out. Effective therapy can be accomplished using the more modern antiplatelet agents with balanced pharmacokinetic and pharmacodynamic properties. Conclusions: Several questions related to treatment of patients with peripheral arterial disease remain to be answered. Expert views on recommended antiplatelet therapy diverge. It would be unethical to ignore the fact that therapy may be ineffective in a proportion of clopidogrel-treated patients. Guidelines for the treatment and prevention of peripheral arterial disease should offer alternative antiplatelet drugs or recommendations to verify a patient´s genetic predisposition. Further clinical trials are warranted to assess the efficacy of individual antiplatelet agents and doses thereof in patients with peripheral arterial disease.

scholarly journals Adherence to Antiplatelet Medications among Persistent and Non-Persistent Older Patients with Peripheral Arterial Disease

Biomedicines ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1800
Author(s):  
Martin Wawruch ◽  
Jan Murin ◽  
Tomas Tesar ◽  
Martina Paduchova ◽  
Miriam Petrova ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Antiplatelet Agents ◽  
Arterial Disease ◽  
Medication Administration ◽  
Study Cohort ◽  
Binary Logistic Regression Model ◽  
Adherence To Medication ◽  
Antiplatelet Medication ◽  
Patient Groups ◽  
Peripheral Arterial

Secondary prevention of peripheral arterial disease (PAD) includes administration of antiplatelet agents, and adherence to medication is a requirement for an effective treatment. The aim of this study was to analyse adherence measured using the proportion of days covered (PDC) index separately in persistent and non-persistent patients, and to identify patient- and medication-related characteristics associated with non-adherence in these patient groups. The study cohort of 9178 patients aged ≥ 65 years in whom PAD was diagnosed in 1/–12/2012 included 6146 persistent and 3032 non-persistent patients. Non-adherence was identified as PDC < 80%. Characteristics associated with non-adherence were determined using the binary logistic regression model. In the group of persistent patients, 15.3% of subjects were identified as non-adherent, while among non-persistent patients, 26.9% of subjects were non-adherent to antiplatelet medication. Administration of dual antiplatelet therapy (aspirin and clopidogrel) and a general practitioner as index prescriber were associated with adherence in both patient groups. Our study revealed a relatively high proportion of adherent patients not only in the group of persistent patients but also in the group of non-persistent patients before discontinuation. These results indicate that most non-persistent PAD patients discontinue antiplatelet treatment rapidly after a certain period of adherence.

scholarly journals P6: ANTIPLATELET AND ANTICOAGULANT USE IN RANDOMISED TRIALS OF PATIENTS UNDERGOING ENDOVASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL DISEASE: SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
MI Qureshi ◽  
HL Li ◽  
GK Ambler ◽  
KHF Wong ◽  
S Dawson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Arterial Intervention ◽  
Arterial Disease ◽  
Endovascular Intervention ◽  
Randomised Trials ◽  
Peripheral Arterial ◽  
High Level

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

scholarly journals Incidence of and factors associated with achieving target lipid levels in patients with peripheral arterial disease

2006 ◽  
Vol 21 (7) ◽  
pp. 711-714 ◽  
Author(s):  
Meggan R. Banta ◽  
Fangchao Ma ◽  
Dawn M. Bravata ◽  
Robert S. Kirsner ◽  
Daniel G. Federman
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Lipid Levels ◽  
Factors Associated ◽  
Peripheral Arterial

Association between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease in Construction Workers-A Cross-Sectional Study

2021 ◽  
Vol 15 (9) ◽  
pp. 2989-2994
Author(s):  
U. Sivakumar ◽  
Rinku Garg ◽  
Sunita Nighute
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Peripheral Arterial Disease ◽  
Pulmonary Disease ◽  
Arterial Disease ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Peripheral Arterial

Objective: COPD has been recognized not only as a lung but also a systemic disease. Smoking is a major cause of COPD, cardiovascular disease, stroke and peripheral arterial disease (PAD). Methods: This was a cross-sectional study conducted at the Department of Physiology, Santosh Medical College diagnosed with COPD using Spirometry was recruited for the study with a sample size of 130 patients. Results: Of the 130 participants, the mean age was 51.73 years of all COPD patients. Thirty-seven (28.46%) were diagnosed to have PAD. Twenty-five patients (19.23%) were overweight, 10 (7.69%) were obese. All the patients included in the study had history of smoking, including current (n= 67, 51.5%) and former (n= 35, 26.9%) smokers. There was no patient with severe respiratory failure in our study. The most common cardiovascular co-morbidity was hypertension (n= 67, 51.5%), followed by diabetes mellitus (n =28, 21.5%), and dyslipidaemia (n= 35, 26.92%). PAD seen in different stages of COPD stage I –IV were 2.94%, 55.88%, 61.76%, 20.58% respectively. Conclusion: The diagnosis of peripheral arterial disease in COPD is important because this is an entity that limits the patient’s physical activity and impairs their quality of life. Lung function was not associated with PAD in patients with COPD. Abnormal ABI results were associated with a higher prevalence of risk factors and more severe lung disease. Keywords: Peripheral Arterial Disease, Smoking, Chronic Obstructive Pulmonary Disease.

Relation between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease among Construction Workers

2021 ◽  
Vol 15 (10) ◽  
pp. 3473-3475
Author(s):  
U. Sivakumar ◽  
Rinku Garg ◽  
Sunita Nighute
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Peripheral Arterial Disease ◽  
Pulmonary Disease ◽  
Arterial Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Increased Risk ◽  
Peripheral Arterial

Introduction: PAD was asymptomatic in a large proportion of COPD patients and was associated with more severe lung disease than in COPD subjects without PAD. Materials and Methods: This was a Cross-sectional study conducted at Department of Physiology, Santosh Medical College diagnosed with COPD using Spirometry was recruited for the study with a Sample size of 130 patients. Results: The characteristics of the population for follow-up (n=130) are presented in table 1. The mean Mean±SD was 51.73±6.1 years. The prevalence of never smokers was 21.5%, former smokers were 51.5% and current smokers were 26.9%. In total, 41 out of 130 individuals (31.5%) had PAD based on an ABI of less than 0.6. A statistically significant association was found between COPD and newly diagnosed PAD during follow-up. The association between COPD and incident PAD was stronger (adjusted OR 1.91, 95% CI 1.14–3.21). Stratified analysis by smoking status revealed that the overall association between COPD and newly developed PAD was driven by the ever smoker group. Conclusion: Subjects with COPD have a higher risk of developing PAD. People with both COPD and PAD have a substantially increased risk of death. Consequently, early detection of PAD and preventive actions in people with COPD should receive more attention in clinical respiratory care. Keywords: Peripheral Arterial Disease, Chronic Obstructive Pulmonary Disease, Ankle-brachial index.

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