Abstract 165: Premature Clopidogrel Discontinuation after Drug-Eluting Stent Placement
Background: Clopidogrel non-adherence is a strong predictor of stent thrombosis, myocardial infarction, and death after drug-eluting stent (DES) placement. Previous studies on the prevalence of premature clopidogrel discontinuation are based on self-report and have short follow-up.
Methods: All patients who underwent DES placement between January 2007 and December 2011 at Parkland Memorial Hospital were considered for inclusion; those with < 1 year follow-up were excluded. We retrospectively collected one-year refill data from a large, closed (county hospital subsidized care) pharmacy system. Our primary outcome was time to failure to obtain a clopidogrel refill, allowing a 5-day grace period.
Results: Of 452 patients (61% male, 38% Hispanic, 29% White, 24% African American) meeting entry criteria English was preferred by 71% of study patients, while 27% preferred Spanish. Median time to failure to obtain a clopidogrel refill was 91 days (Figure). By 6 months 58% of patients and by 12 months 85% of patients had failed to obtain a refill allowing a 5-day grace period. At follow-up 26% of patients had failed to obtain their first refill within 5-days after first prescription ending. By one year follow-up, 21% of patients had 100% proportion of days covered (PDC), 60% had PDC ≥ 80%, and 40% had PDC < 80%.
Conclusions: We identified a high prevalence of clopidogrel non-adherence in a multi-ethnic urban poor patient population, despite the facts that clopidogrel was provided on discharge and at nominal cost ($5 per month) thereafter, that patients were identified by treating physicians as likely to adhere to treatment, and that intensive patient education on the importance of clopidogrel adherence post-DES was routinely provided. These data call into question the implicit assumptions made about clopidogrel adherence in routine clinical practice.
Author Disclosures: H. Khalili: None. E.E. Moss: None. M. Wood: None. R. Singh: None. A. Edwards: None. J. Berry: D. Speakers; Modest; Merk & Co. W. Vongpatanasin: None. J.A. de Lemos: G. Consultant/Advisory Board; Modest; Astra Zeneca. S.R. Das: None.
- © 2014 by American Heart Association, Inc.