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Barriers to clopidogrel adherence following placement of drug-eluting stents
Maria José Pallares1, Eric R Powers, Peter L Zwerner
1South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA. mjpallares@gmail.com
Insights
Nonadherence to clopidogrel after drug-eluting stent placement is common, with medical barriers like rash being significant factors. Improving patient counseling and support is crucial for better medication adherence.
Area of Science:
- Cardiology
- Pharmacology
- Patient Adherence Research
Background:
- Nonadherence to clopidogrel post-drug-eluting stent (DES) placement increases risks of in-stent thrombosis and adverse cardiac events.
- Understanding adherence challenges is critical for patient outcomes.
Purpose of the Study:
- To determine the incidence of clopidogrel nonadherence in patients with DES.
- To identify key barriers contributing to nonadherence in this population.
Main Methods:
- A cohort of patients receiving DES between March 2004 and August 2005 were interviewed 6+ months post-discharge.
- Nonadherence was defined as premature discontinuation or <80% adherence.
- Barriers were self-reported, and statistical analyses compared adherent and nonadherent groups.
Main Results:
- The study included 257 of 674 eligible patients; 20% were nonadherent, with 58% discontinuing therapy early.
- Medical barriers, particularly perceived adverse effects (e.g., rash), were primary reasons for discontinuation.
- Financial barriers were reported by both groups, but nonadherent patients were less likely to have medication insurance coverage.
Conclusions:
- A significant portion of patients exhibit nonadherence to clopidogrel after DES placement.
- Targeted interventions addressing medical and financial barriers, alongside improved discharge counseling, are needed.
- Further prospective research is essential to identify at-risk patients and mitigate risks of in-stent thrombosis.
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 chi(2) 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.
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