Loading…
Barriers to Clopidogrel Adherence Following Placement of Drug-Eluting Stents
Background: Nonadherence to clopidogrel after drug-eluting stent (DES) placement is associated with in-stent thrombosis and adverse cardiac events. Objective: To identify the incidence of and barriers associated with nonadherence to clopidogrel in patients receiving DES. Methods: Patients who receiv...
Saved in:
Published in: | The Annals of pharmacotherapy 2009-02, Vol.43 (2), p.259-267 |
---|---|
Main Authors: | , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Summary: | Background:
Nonadherence to clopidogrel after drug-eluting stent (DES) placement is associated with in-stent thrombosis and adverse cardiac events.
Objective:
To identify the incidence of and barriers associated with nonadherence to clopidogrel in patients receiving DES.
Methods:
Patients who received a DES between March 1, 2004, and August 31, 2005, from a single academic medical center were eligible. Telephone interviews were conducted 6 or more months following discharge. Nonadherence was defined as premature discontinuation of or less than 80% adherence to clopidogrel. Patients were asked to identify barriers to adherence. Differences between adherent and nonadherent patients were analyzed using χ2 and t-test analysis.
Results:
Of the 674 patients identified, 257 (38%) participated. The nonadherence rate was 20%. The majority (58%) of nonadherent patients discontinued therapy prematurely. Patients identified the main reason for discontinuation as medical barriers (18.56%), including perceived adverse effects (9.28%). The Incidence of rash was higher in patients who were nonadherent (12% vs 4%; p = 0.049). Overall, 49% of patients recalled receiving discharge counseling regarding adverse effects. A financial barrier was identified by 22 (42%) patients in the nonadherent and 73 (36%) in the adherent group, of whom 64% and 52%, respectively, reported having insurance coverage for medications. Adherent patients reported higher copays ($29.69 vs $18.14; p = 0.01).
Conclusions:
Prospective studies should be conducted to aid in identifying patients at risk for nonadherence and possible in-stent thrombosis in order to identify interventions to improve adherence. |
---|---|
ISSN: | 1060-0280 1542-6270 |
DOI: | 10.1345/aph.1L236 |