Delays in Filling Clopidogrel Prescription After Hospital Discharge and Adverse Outcomes After Drug-Eluting Stent Implantation

Abstract

Background-Adjuvant clopidogrel therapy is essential after drug-eluting stent (DES) implantation. The frequency with which patients delay filling a clopidogrel prescription after DES implantation and the association of this delay with adverse outcomes is unknown. Methods and Results-This was a retrospective cohort study of patients discharged after DES implantation from 3 large integrated health care systems. Filling a clopidogrel prescription was based on pharmacy dispensing data. The primary end point was all-cause mortality or myocardial infarction (MI). Of 7402 patients discharged after DES implantation, 16% (nϭ1210) did not fill a clopidogrel prescription on day of discharge and the median time delay was 3 days (interquartile range, 1 to 23 days). Compared with patients filling clopidogrel on day of discharge, patients with any delay in filling clopidogrel had higher death/MI rates during follow-up (14.2% versus 7.9%; PϽ0.001). In multivariable analysis, patients with any delay had increased risk of death/MI (hazard ratio, 1.53; 95% confidence interval, 1.25 to 1.87). Patients with any delay remained at increased risk of adverse outcomes when the delay cutoff was changed to Ͼ1, Ͼ3, or Ͼ5 days after discharge. Factors associated with delay included older age, prior MI, diabetes, renal failure, prior revascularization, cardiogenic shock, in-hospital bleeding, and clopidogrel use within 24 hours of admission. Conclusions-One in 6 patients delay filling their index clopidogrel prescription after hospital discharge after DES implantation. This delay was associated with increased risk of adverse outcomes and highlights the importance of the transition period from hospital discharge to outpatient setting as a potential opportunity to improve care delivery and patient outcomes. (Circ Cardiovasc Qual Outcomes. 2010;3:261-266.)

Clopidogrel Use and Hospital Quality in Medically Managed Patients With Non–ST-Segment–Elevation Myocardial Infarction

“…However, prior studies have demonstrated that gaps in both prescription and use of secondary prevention medications, such as clopidogrel, at hospital discharge, are often magnified rather than reduced in the outpatient setting. 13,14 Second, incomplete or inaccurate documentation of clopidogrel contraindication could cause our characterization of a gap to be overstated. However, data abstraction for the ACTION Registry-GWTG is subject to data quality methods, which minimizes this potential bias.…”

Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications

“…These results are consistent with other studies that analyzed patients who received their prescription for clopidogrel successfully on the day of hospital discharge after DES implantation against patients who delayed the purchase of clopidogrel. The latter group was found to have a higher probability of sudden death or recurrent myocardial infarction (14.2% vs. 7.9%; p < 0.001) [40]. One study demonstrated that as many as 1 in 7 patients treated with DES discontinued thienopyridines therapy (clopidogrel, prasugrel or ticlopidine) without any reasonable medical reason within the first month following their procedure [41].…”

Pharmacist-Coordinated Multidisciplinary Hospital Follow-up Visits Improve Patient Outcomes

“…These errors include discontinuation of prescribed medications; noncompliance, including failure to fill medications or failure to be adherent; and delays in filling medications. [5][6][7] In the geriatric population, the most frequently reported unwanted events after discharge were related to prescription medication regimens mainly due to patients getting incorrect drugs or dosages. 8 Literature to date shows that some pharmacist interventions before and after discharge decrease medication-related errors.…”