Clopidogrel delay post-stenting linked to death and MI risk

Delay > 3 days was predictive of mortality & recurrent MI irrespective of stent types

A STUDY done in the United Kingdom found that delayed filling of first prescription for clopidogrel after coronary stenting are commonly associated with adverse clinical outcomes like death and myocardial infarction (MI), regardless of the kind of stent used.

“A delay of more than three days in filling a first prescription for clopidogrel after hospital discharge was associated with an increased risk of death, readmission with MI, and the combined endpoint of death and readmission of MI during long-term follow-up, irrespective of the type of stent used,” wrote the authors led by Nicholas Cruden, MBChB, PhD of the Department of Cardiology, Royal Infirmary of Edinburgh in the UK.

The objective of the study was to investigate the effect of a delay in filling a first clopidogrel prescription after hospital discharge on clinical outcomes following coronary stenting. This study was done on the back of the patients’ frequency of experiencing difficulties in medication compliance after being discharged.

The researchers studied a sample size of 15,629 patients who were treated with coronary stents. Of that number, 3,599 were given at least one drug-eluting stent DES) and 12,030 were given a bare metal stents (BMS). One thousand sixty four patients (30 percent) in the DES group and 3,758 patients (31 percent) in the BMS group failed to fill a prescription within three days of discharge.

“After regression analysis, a delay of more than three days was predictive of mortality and recurrent myocardial infarction irrespective of stent types,” wrote the authors.

Two years after the index period 1,055 patients or seven percent died, including 183 in the DES cohort and 871 in the BMS cohort. Meanwhile, 1,004 or six percent were readmitted with MI, including 228 from the DES study and 776 from eh BMS study.

“Almost one in three patients failed to fill a community prescription of clopidogrel within three days of hospital discharge. This concerting figure is consistent with previous work,” wrote the authors.

The authors suggested that identification of strategies to avoid delays in obtaining the first community prescription for clopidogrel may lead to improved clinical outcomes in this population. With JAMA report

VitalSigns Issue 64 Vol. 3, June 1-30, 2014