Many stent patients delay taking clopidogrel with adverse results
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Patients who delay filling their clopidogrel prescription for even a day after discharge post-implantation of a drug-eluting stent (DES) have a higher risk of death or myocardial infarction (MI).
A retrospective cohort study included 7,402 patients who received a DES at one of three large integrated health centers. According to pharmacy records, 16% of the patients did not fill their prescriptions for clopidogrel on the day of discharge. Patients who did fill the scripts had a 7.9% risk of death or myocardial infarction compared to 14.2% among those who didn't, with a large proportion of the adverse events occurring within the first 30 days after discharge. Patients were less likely to fill the prescription if they were older or had more comorbidities. The study appears in the May issue of Circulation: Cardiovascular Quality and Outcomes.
Whether patients delayed by only one day or more than five had no significant impact on their increased risk, which may be due to the loading dose, patients metabolizing clopidogrel differently or the possibility that they don't start taking the drug the day they pick it up. The study also found that delay in filling prescriptions for statins did not increase risk, although they could not collect data on compliance with aspirin therapy. The researchers also noted that patients who delayed filling the initial clopidogrel prescription were more likely to have gaps between subsequent refills.
The study's results may actually underestimate the degree of the problem, the authors noted, because all patients in the study had prescription drug coverage. The findings highlight the importance of ensuring that patients take clopidogrel as prescribed and thereby reduce their risk of stent thrombosis. In order to accomplish this goal, the lead author of the study said in a press release that hospitals should ensure that patients receive a follow-up phone call from a pharmacist or nurse soon after discharge, in addition to general efforts to improve the quality of discharge transitions.