Clinician-patient discord: exploring differences in perspectives for discontinuing clopidogrel

Area of Science:

• Cardiology
• Patient Adherence
• Pharmacology

Background:

• Premature cessation of anti-platelet therapy post-drug-eluting stent (DES) implantation poses significant risks for myocardial infarction (MI) patients.
• Understanding the multifaceted reasons behind therapy discontinuation is crucial for patient safety.

Purpose of the Study:

• To investigate patient and clinician perspectives on why MI patients discontinue clopidogrel therapy prematurely after DES implantation.
• To identify discrepancies in perceived reasons for premature drug cessation between patients and healthcare providers.

Main Methods:

• A qualitative, descriptive study involving interviews with 22 MI patients treated with DES and 17 clinicians (physicians and nurse practitioners).
• Content analysis of interview data was performed to compare patient and clinician viewpoints on clopidogrel discontinuance.

Main Results:

• Patients most frequently cited a lack of clear communication and education regarding clopidogrel's necessity and prescribed duration as reasons for stopping.
• Cost was rarely identified by patients as a reason for discontinuation, contrasting with clinicians who frequently cited cost as a primary factor.

Conclusions:

• A significant gap exists between patient and clinician perceptions regarding the main drivers of premature clopidogrel cessation.
• Enhancing physician-patient communication about the importance and duration of clopidogrel therapy is a critical, actionable strategy to improve adherence.