If you have patients who have just undergone coronary artery stent implantation, make sure that they comply promptly with their instructions for clopidogrel use. The early and as-directed use of this anti-clotting medication may save their lives.

That is the conclusion of a large study based on the medical records of more than 15,000 patients in British Columbia who received either a bare-metal stent (BMS) or a drug-eluting stent (DES) between 2004 and 2006. To reduce the risk of stent thrombosis, postoperative guidelines advise patients undergoing BMS implantation to take clopidogrel together with aspirin for 1 month. 

Patients undergoing DES implantation are instructed to follow this regimen for 6 to 12 months. But the real problem, according to cardiologist Nicholas L. Cruden, MBChB, PhD, lead author of the Journal of the American Heart Association study, lies in compliance immediately after discharge. A delay in filling that first clopidogrel prescription may lead to myocardial infarction or even death.

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Approximately 30% of the British Columbia patients failed to fill a clopidogrel prescription within 3 days of leaving the hospital. Compared with patients who filled their prescriptions promptly, those who delayed were:
  • 3 times as likely to suffer a myocardial infarction within 1 month
  • 5 times as likely to die of any cause within 1 month
  • twice as likely to have a myocardial infarction or to die of any cause within 2 years.

“This study highlights the importance of ensuring patients have access to medications as soon as they leave the hospital,” observed Cruden in an American Heart Association statement. “Even a delay of a day or two was associated with worse outcomes.”

Along those lines, Cruden suggested that discharging patients from the hospital with enough medicine for the highest-risk period–the first 30 days — could be very helpful.