Delay in filling a blood-thinner prescription after procedures to implant a drug-eluting stent is risky
Patients who receive a drug-eluting stent to keep a coronary artery open should take the blood-thinner clopidogrel without interruption once they are discharged from the hospital. This drug prevents the formation of blood clots and is usually prescribed for 1 year following drug-eluting stent insertion. Most of the 7,402 patients in the study filled the clopidogrel prescription on the day they were discharged from the hospital. But the 1,210 patients (16.3 percent) who waited more than a day after hospital discharge to fill the prescription, and are therefore assumed to have an interruption in their clopidogrel therapy, had an increase in death or heart attacks. Patients who filled the blood-thinner prescription promptly had a lower rate of adverse outcomes (7.9 percent) than those who delayed or did not fill the prescription (14.2 percent). The 54 percent increased risk of adverse events in patients who delayed filling clopidogrel prescriptions remained consistent even after adjusting for delays in filling other heart medicines (e.g., statins, beta blockers) and for adherence to these medications. The patients most likely to delay filling their blood-thinner prescription were older than 65 years or had a coexisting condition such as diabetes, a prior heart attack, or kidney disease.
The researchers gathered their patient data from linked clinical registry and administrative data from three integrated health care delivery systems. The primary outcome was all-cause mortality or heart attack after patients had received a drug-eluting stent. Based on their findings, the researchers suggest that patients who receive stents might benefit from talking with a pharmacist or "transition coach" to review their medications at hospital discharge.
The study was funded in part by the Agency for Healthcare Research and Quality (HS16955) to the HMO Research Network Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, go to http://www.certs.hhs.gov.
More details are in "Delays in filling clopidogrel prescription after hospital discharge and adverse outcomes after drug-eluting stent implantation: Implications for transitions of care," by P. Michael Ho, M.D., Ph.D., Thomas T. Tsai, M.D., M.Sc., Thomas M. Maddox, M.D., M.Sc., and others in the May 2010 Circulation: Cardiovascular Quality and Outcomes 3, pp. 261-266.
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