Prescription Delay Following Stent Implantation Is a Common and Deadly Problem

May 28th, 2014

Prescription Delay Following Stent Implantation Is a Common and Deadly Problem

Larry Husten, PHD

After receiving a stent, many patients delay or fail to fill their prescription for clopidogrel or another antiplatelet agent. Now, a study published in the Journal of the American Heart Association offers evidence that this problem is widespread and often leads to serious consequences.

Researchers analyzed data from all stent implantations performed in British Columbia from 2004 through 2006. In all, 15,629 stents were implanted: 3,599 patients received at least one drug-eluting stent (DES), and 12,030 received bare metal stents (BMS) alone. Nearly a third of the patients in each stent group did not fill their prescription within 3 days after leaving the hospital.

A delay of 3 or more days in filling a first prescription for clopidogrel after hospital discharge was associated with significant increases in the risk for death and readmission with MI at 2 years:

DES group: 18% in the delay group versus 8% (hazard ratio, 2.0, CI 1.6 – 2.6)
BMS: 22% versus 8% (HR 2.0, CI 1.8 – 2.3)

The increased risk was most evident in the first 30 days. Patients who never filled their prescription had the worst outcomes — DES patients who never filled their prescription had a 12-fold increase in the risk for death, while BMS patients had a 5-fold increase.

The authors observe that medication compliance is particularly important following a stent implant: “The risk of coronary stent thrombosis appears highest in the early period after stent implantation and reduces in the subsequent weeks to months. This coincides with a period immediately after hospital discharge when patients often experience difficulties with medication compliance, the most common issue being failure or a delay to fill a discharge prescription.”

“This study highlights the importance of ensuring patients have access to medications as soon as they leave the hospital,” said the lead author of the paper, Nicholas Cruden, in an AHA press release. “Even a delay of a day or two was associated with worse outcomes.”

CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

May 28th, 2014