Delay in filling clopidogrel prescription after coronary stent linked to adverse clinical outcomes

A delay in filling the first prescription for clopidogrel after coronary stenting is associated with an increased risk of death and myocardial infarction (MI), according to a study published online May 28 in the Journal of the American Heart Association.

Researcher Nicholas L. Cruden, PhD, and colleagues conducted a retrospective, data linkage study in British Columbia who had a coronary artery stent implanted from 2004 to 2007. They wanted to investigate the effect of a delay in filling a first clopidogrel prescription after hospital discharge on clinical outcomes following coronary stenting.

Of 15,629 patients treated with coronary stents, 3,599 received at least 1 drug-eluting stent (DES) and 12,030 received bare-metal stents alone.

“Thirty percent of patients failed to fill a prescription for clopidogrel within 3 days of hospital discharge,” Cruden said. “Delay in filling a first community prescription for clopidogrel was associated with a 5-fold increase in mortality and 3-fold increase in risk of MI in first 30 days following discharge after percutaneous coronary intervention [PCI] procedures.”

The findings highlight the importance of ensuring adherence/compliance with antiplatelet therapy post-PCI and the need to address barriers (geographical, financial, social, etc.) to patients obtaining prescriptions, according to Cruden.

“We know that premature discontinuation/interruption of clopidogrel post-PCI is associated with adverse events, the risk of stent thrombosis/reinfarction greatest in 30 days after PCI, and this coincides with the time when patients transition from hospital to home and frequently have difficulties with medication compliance,” he said.