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Policy Change Improves Cardiovascular Outcomes

Canadian removal of prior-authorization policy for clopidogrel beneficial to heart attack patients

WEDNESDAY, Oct. 22 (HealthDay News) -- In patients aged 65 and older who undergo percutaneous coronary intervention with stenting after a heart attack, liberalized access to clopidogrel significantly improves cardiovascular outcomes, according to study findings published in the Oct. 23 issue of the New England Journal of Medicine.

Cynthia A. Jackevicius, of the Western University of Health Sciences in Pomona, Calif., and colleagues compared outcomes in older Canadian patients before and after the provincial government switched from a prior-authorization policy to a less restrictive, limited-use policy on access to clopidogrel.

The researchers found that the rate of clopidogrel use within 30 days after hospital discharge increased from 35 percent to 88 percent, the time to first administration of clopidogrel decreased from nine days to zero days, and that the composite rate of death, recurrent acute myocardial infarction, percutaneous coronary intervention and coronary-artery bypass grafting at one year decreased from 15 percent to 11 percent.

"Although clopidogrel is an expensive medication for a drug formulary, a limitation of access to the drug under a prior-authorization policy in patients after percutaneous coronary intervention with stenting was associated with an increased rate of cardiac events," the authors conclude. "The process of limiting access to cardiac medications that are acutely required may merit reconsideration."

Several of the study authors reported receiving lecture fees and grants from pharmaceutical companies.

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