Factors associated with clopidogrel use, adherence, and persistence in patients with acute coronary syndromes
Baojin Zhu1, Zhenxiang Zhao, Patrick McCollam
1Eli Lilly and Company, Indianapolis, Indiana 46285, USA. ZHU_BAOJIN@LILLY.COM
Insights
In patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI), factors like younger age and certain comorbidities negatively impacted clopidogrel adherence. Understanding these factors can help improve medication compliance.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Recent guidelines advocate for dual antiplatelet therapy (DAPT) with aspirin and clopidogrel or prasugrel for at least 12 months post-percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS) patients.
- Clopidogrel adherence is crucial for preventing stent thrombosis and adverse cardiovascular events following PCI.
Purpose of the Study:
- To investigate factors influencing clopidogrel use and adherence among ACS patients who underwent PCI.
- To identify patient demographics, comorbidities, and prior medication use associated with clopidogrel prescribing and adherence patterns.
Main Methods:
- Analysis of the US MarketScan commercial claims database for 10,465 ACS patients undergoing PCI (2005-2006).
- Multivariate logistic regression models were employed to determine predictors of clopidogrel use and adherence (defined as medication possession ratio ≥80%).
- Factors examined included patient demographics, comorbidities (hypertension, diabetes, atrial fibrillation), and prior use of beta-blockers, statins, and ACE inhibitors (BSI).
Main Results:
- Clopidogrel use was high (92.8%), but only 66.8% of users were adherent.
- Factors associated with decreased clopidogrel use included PCI without stenting, hypertension, diabetes, and atrial fibrillation.
- Younger age, prior clopidogrel use, and prior BSI medication use were linked to increased clopidogrel use.
- Non-adherence was associated with prior clopidogrel use, prior hospitalization, chronic pulmonary disease, PCI without stenting, diabetes, and younger age.
- Prior BSI medication use was associated with increased adherence.
Conclusions:
- Patient characteristics such as younger age, specific comorbidities (diabetes, chronic pulmonary disease), prior hospitalization, and undergoing PCI without stenting negatively impact clopidogrel adherence.
- These findings highlight the need for targeted interventions to enhance thienopyridine compliance in ACS patients.
- Understanding patient profiles and medication history is key to improving adherence and clinical outcomes.
Objective:
Recent guidelines recommend use of aspirin and either clopidogrel or prasugrel for at least 12 months following use of drug-eluting or bare metal stents in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). This study evaluated factors associated with clopidogrel use and adherence in ACS patients following PCI.
Research Design And Methods:
The US employer-based MarketScan commercial claims database was used to examine factors associated with clopidogrel use and adherence. Adherence was defined as a medication possession ratio of 80% or higher. Multivariate logistic regression analyses were conducted to identify factors associated with clopidogrel use and adherence and included patient demographics, comorbidities, and prior beta-blocker, statin, and angiotensin converting enzyme inhibitor (BSI) use as factors.
Results:
A total of 10,465 patients aged 18-65 years who met inclusion criteria were hospitalized for ACS and underwent PCI between 01/01/2005 and 12/31/2006. Overall, the rate of clopidogrel use was 92.8% for ACS-PCI patients and 66.8% of the clopidogrel users were adherent. Receiving PCI without stenting (Odds Ratio [OR] = 3.28), comorbid hypertension (OR = 1.50), diabetes (OR = 1.49), and atrial fibrillation (OR = 1.91) were associated with decreased filled prescriptions for clopidogrel. Younger age (OR = 0.83) and prior use of clopidogrel (OR = 0.54) or other BSI medications (OR = 0.44) were associated with increased use of clopidogrel (all p values < 0.05). Factors significantly associated with non-adherence of clopidogrel were prior use of clopidogrel (OR = 1.40), prior hospitalization (OR = 1.34), chronic pulmonary disease (OR = 1.31), PCI without stenting (OR = 1.32), diabetes (OR = 1.17), and younger age (OR = 1.29). Prior use of BSI medications (OR = 0.82) increased adherence to clopidogrel.
Conclusions:
Prior use of clopidogrel, comorbid conditions such as diabetes and chronic pulmonary disease, prior hospitalization, PCI without stenting, and younger age had a negative impact on clopidogrel adherence. These findings may assist programs to improve thienopyridine compliance through a better understanding of patients' disease profiles and concomitant medication use.
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