Credit: CDC
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Patients who delay filling a prescription of clopidogrel after coronary stenting may increase their risk of recurrent myocardial infarction (MI) and death, according to a study published in the Journal of the American Heart Association.
Researchers analyzed records of more than 15,000 patients who received drug-eluting or bare metal stents.
Roughly 30% of patients in each group failed to fill their prescription of the anticoagulant clopidogrel within 3 days of hospital discharge.
And this roughly doubled the patients’ risk of death and recurrent MI, regardless of their stent type.
“It is very important that patients take clopidogrel after having a coronary stent implanted to prevent blood clots forming within the stent,” said study author Nicholas Cruden, MBChB, PhD, of the Royal Infirmary of Edinburgh in the UK.
He and his colleagues analyzed hospital administrative, community pharmacy, and cardiac revascularization data from all patients who received a coronary stent in British Columbia between 2004 and 2006, with follow-up out to 2 years.
Of the 15,629 patients, 3599 had received at least 1 drug-eluting stent (DES), and 12,030 had received a bare metal stent (BMS). Thirty percent (n=1064) of patients in the DES group, and 31% (n=3758) of patients in the BMS group failed to fill their prescription for clopidogrel within 3 days of hospital discharge.
And a delay of more than 3 days was predictive of mortality and recurrent MI, regardless of the stent type. The hazard ratios (HRs) for mortality were 2.4 for the DES group and 2.2 for the BMS group. The HRs for recurrent MI were 2.0 and 1.8, respectively.
The excess risk associated with a delay in filling the prescription was greatest in the immediate period after hospital discharge—up to 30 days. In all patients, the HRs were 5.5 for mortality and 3.1 for recurrent MI.
Delaying filling the prescription for more than 3 days remained an independent predictor of death and MI beyond 30 days from hospital discharge. The HRs were 2.1 and 2.0, respectively, for patients in the DES group and 2.0 and 1.8, respectively, for patients in the BMS group.
“This study highlights the importance of ensuring patients have access to medications as soon as they leave the hospital,” Dr Cruden said. “Even a delay of a day or 2 was associated with worse outcomes.”
Discharging patients from the hospital with enough medicine for the highest-risk period (the first month or so) could help, he added.
