Medication Use Crucial After Stent Placement

Heart attack patients who didn't follow regimen had 9-fold higher death risk, study says

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MONDAY, June 12, 2006 (HealthDay News) -- Patients who receive a drug-emitting stent after heart attack but don't follow their prescribed drug regimen boost their risk for death nine-fold, a new study finds.

In the study, heart attack patients who stopped taking their prescribed anticoagulants within 30 days of their stenting surgery faced a much higher risk of death than those who remained compliant with their drugs.

"An alarming one in seven patients in our study stopped taking their antiplatelet medication within the first 30 days of receiving a drug-eluting [emitting] stent, even though they were prescribed the drugs at the time of hospital discharge and recommendations are to continue them for a minimum of three to six months after the procedure," study author Dr. John A. Spertus, director of cardiovascular education and outcomes research at the Mid-America Heart Institute in Kansas City, said in a prepared statement.

Researchers studied 500 heart attack patients from 19 different heart centers, average age 61, who had had surgery to implant a drug-eluting stent, a tiny mesh tube that props open arteries and is also impregnated with drugs that help prevent artery re-closure.

Although all of these patients left the hospital with a prescription for an anticoagulant, 68 patients (13.6 percent) stopped taking their prescribed medications within 30 days of discharge. The anticoagulants prescribed in this study were in a drug class called thienopyridines, which includes clopidogrel (Plavix) and ticlopidine.

One year after discharge, the researchers noted that 7.5 percent of the patients who were noncompliant with their medications after 30 days had died, while only 0.7 percent of patients who took their anticoagulant medications as prescribed died.

"The rate of death was significantly higher, and the frequency of cardiac hospitalizations was almost twice as great over the next 11 months among those who stopped their thienopyridines as compared to those who continued them," said Spertus.

The study, which appears in the June 13 issue of Circulation, also noted that 23 percent of noncompliant patients were readmitted to the hospital within one year after discharge from the stenting surgery, while just 14 percent of compliant patients were readmitted.

"Results indicate that more patient education about why the medicine is necessary could save lives. Treatment decisions made at the height of clinical urgency can have long-lasting consequences on the chronic care that patients need to have the best possible outcomes," Spertus said. "In this case, prolonged use of thienopyridines after drug-eluting stent implantation for heart attack treatment is clearly required for patients to get all the benefits of reduced restenosis and to avoid the catastrophic complication of stent clotting."

More information

The Society for Vascular Surgery has more information on stenting.

SOURCES: American Heart Association, news release, June 12, 2006

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