QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pallares, M. J. Articles by Nappi, J. M Search for Related Content PubMed PubMed Citation Articles by Pallares, M. J. Articles by Nappi, J. M

ANTICOAGULATION

Barriers to Clopidogrel Adherence Following Placement of Drug-Eluting Stents

at time of writing, Pharmacy Resident, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC; now, Clinical Pharmacist, Miami Veterans Affairs Medical Center – Pharmacy Services, Miami, FL

Eric R Powers, MD

Professor of Medicine, Medical University of South Carolina

Peter L Zwerner, MD

Assistant Professor of Medicine, Medical University of South Carolina

Andrew Fowler, MD

at time of this study, Cardiology Fellow, Medical University of South Carolina; now, Interventional Cardiologist, Chattanooga Heart Institute, Chattanooga, TN

Rodney Reeves, MD

at time of this study, Medicine Resident, Medical University of South Carolina; now, Cardiology Fellow, Louisiana State University Health Sciences Center, Shreveport LA

Jean M Nappi, PharmD FCCP BCPS

Professor of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, Medical University of South Carolina

Reprints: Dr. Pallares, Miami Veterans Affairs Medical Center–Pharmacy Services, 1201 NW 16th St., Miami, FL 33125, fax 305/575-3386, mjpallares{at}gmail.com

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 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.

Key Words: adherence, clopidogrel, drug-eluting stents

Published Online, February 3, 2009. www.theannals.com, DOI 10.1345/aph.1L286