Delaying Clopidogrel After Stent Placement May Be Deadly

Rate of heart attack or death is nearly doubled in patients who fill prescription after discharge day

TUESDAY, April 20 (HealthDay News) -- Many patients who have had a drug-eluting stent (DES) inserted delay filling a prescription for clopidogrel after discharge from the hospital, and, as a result, they face nearly double the risk of heart attack or death, according to research published online April 20 in Circulation: Cardiovascular Quality and Outcomes.

P. Michael Ho, M.D., of Kaiser Permanente of Colorado in Denver, and colleagues retrospectively reviewed the records of a cohort of 7,402 patients discharged from three large health care systems after placement of a DES. The primary end points were subsequent myocardial infarction (MI) or all-cause mortality.

Compared to patients who filled their clopidogrel prescription on the date of discharge, the researchers found that patients with any delay had much higher rates of death/MI during the follow-up period (14.2 versus 7.9 percent). The authors note that 16.3 percent of patients did not fill their prescription on the day of discharge; the median delay was three days, and the longest delay was 23 days. Even when the delay period was redefined as being greater than three days or greater than five days, those with delay had higher death/MI outcomes than did those who were under the delay threshold. Older age, in-hospital bleeding, and the presence of one or more of several comorbid diagnoses were associated with a delay in filling the clopidogrel prescription.

"We found that one in six patients delayed filling their initial clopidogrel prescription and this delay was associated with an increased risk of death/MI," the authors write. "In addition, filling a new statin prescription late was not associated with adverse outcomes suggesting that the association between the delay in filling a prescription and adverse outcomes was specific to clopidogrel. These findings suggest the need for quality improvement efforts to ensure that patients fill their clopidogrel prescription in a timely manner after DES implantation."

Ho serves as a consultant for Wellpoint Inc.

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