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Delays in filling clopidogrel prescription common after coronary stenting
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Delays in filling a first prescription for clopidogrel are common after coronary stenting. However, such delays are associated with adverse clinical outcomes, according to new study results.
Researchers utilized the Cardiac Services British Columbia Registry to identify 15,629 patients who underwent PCI in British Columbia from 2004 to 2006. This information was then linked to the Pharmanet and British Columbia Ministry of Health Vital Statistics and Hospitalizations databases to compile information on patient demographics, index PCI procedure, initial clopidogrel prescription and clinical outcomes. Follow-up data were available on all patients for up to 2 years after PCI.
Of all patients who underwent stenting, 3,599 received at least one drug-eluting stent while 12,030 received bare-metal stents alone.
Thirty percent of patients in the DES group and 31% in the BMS group failed to fill the initial prescription for clopidogrel within 3 days of discharge. Regression analysis revealed that a delay of more than 3 days was associated with mortality and recurrent MI, regardless of stent type. With DES, the HR for mortality was 2.4 (95% CI, 1.7-3.4) and the HR for MI was 2 (95% CI, 1.5-2.7); with BMS, the HR for mortality was 2.2 (95% CI, 1.9-2.6) and the HR for MI was 1.8 (95% CI, 1.5-2.1).
The increased risk for death and MI was greatest in the first month after discharge for all patients (mortality, HR=5.5; 95% CI, 3.5-8.6; MI, HR=3.1; 95% CI, 2.4-4).
“Identifying strategies to avoid delays in obtaining a first community prescription for clopidogrel may lead to improved clinical outcomes in this population,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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