Stent Patients Raise Their Risks by Delaying Clopidogrel Prescriptions

April 20, 2010—The American Heart Association announced the publication of a study by Michael Ho, MD, et al that states that one in six patients who have a drug-coated stent inserted do not immediately fill a clopidogrel prescription upon hospital discharge, increasing their risk for subsequent heart attack and death. The study has been published online ahead of print in Circulation: Cardiovascular Quality and Outcomes.

“A surprising number of patients delayed filling the prescription,” commented Dr. Ho. “We expected their physicians and the health care system to be more vigilant in making sure they got their medications.”

He stated further, “When cardiac patients are discharged from the hospital, they are prescribed a lot of medications and may not remember the importance of all of them, specifically clopidogrel. In addition, the doctors in the hospital may not know who is providing their patients follow-up care, and often there is a gap in the transfer of information from inpatient to outpatient settings. We need to improve this transition period from hospital to home and make sure patients understand the importance of their medications.”

The investigators examined records from 7,402 patients from 2004 to 2007 who were able to obtain prescription drugs at reduced costs through their health plans. These patients had not been prescribed clopidogrel in the 3 months before their stent procedure. It was found that 16.3% of patients (1,210) waited at least a day to fill the blood-thinner prescription, and of those, 2.2% (165) never filled their prescription. The median delay was 3 days.

Over approximately 22 months of follow-up, patients who had any delay in filling the prescription had a 14.2% risk of heart attack or death—almost double the 7.9% risk of those who filled their prescription the day of discharge from the hospital. Patients who did not immediately fill their prescription were older and more likely to have other health conditions that required additional prescriptions, researchers found. Those who delayed filling the first prescription also delayed getting subsequent refills of clopidogrel.

The investigators suggested that a nurse or pharmacist should give follow-up calls to patients soon after discharge to increase the number of patients who fill their medications in a timely manner and take the medication as prescribed, The caller would review the patients' medications to make sure they know when to take them and for how long.
Dr. Ho said, “Each hospital should review its discharge process to understand if there are potential gaps, and if there are gaps, design interventions to improve this transition period.”