Barriers to clopidogrel adherence following placement of drug-eluting stents

Maria José Pallares, Eric R. Powers, Peter L. Zwerner, Andrew Fowler, Rodney Reeves, Jean M. Nappi

Research output: Contribution to journalArticlepeer-review

Abstract

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 patents 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 χ 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.

Original languageEnglish
Pages (from-to)259-267
Number of pages9
JournalAnnals of Pharmacotherapy
Volume43
Issue number2
DOIs
Publication statusPublished - Feb 2009
Externally publishedYes

Keywords

  • Adherence
  • Clopidogrel
  • Drug-eluting stents

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