Many Delay Blood Thinners After Stent Placement, Risking Death
WEDNESDAY, May 28, 2014 -- Many patients undergoing coronary stent placement don't fill their prescription for vital blood-thinning medication within the recommended time frame, a lapse leaving them much more likely to die within a month, new research suggests.
Researchers found that 30 percent of stent patients neglect to start taking Plavix (clopidogrel) as directed within three days of hospital discharge. This can triple their risk of heart attack and quintuple their risk of death over the following 30 days, the study authors said.
"What was surprising was the fact that almost a third of patients experienced some sort of delay and that any delay, even by a day, appeared to be associated with some increased risk," said study author Dr. Nicholas Cruden, a consultant cardiologist at Edinburgh Heart Center of the Royal Infirmary of Edinburgh in Scotland.
"This highlights the difficulties patients often experience with medication on the transition from hospital to community and the importance of compliance with anti-platelet treatment after coronary artery stenting, particularly in the early period following implantation," Cruden added.
The study is published in the May 28 edition of the Journal of the American Heart Association.
Designed to reduce heart attack risk, coronary stents are surgically implanted in about 454,000 Americans each year, according to the U.S. Centers for Disease Control and Prevention. Stents are small mesh tubes that essentially prop open plaque-narrowed arteries.
A drug regimen of clopidogrel plus aspirin is advised for one month for patients with bare metal stents and for six to 12 months in patients with a so-called drug-eluting stent, which is coated with medication to help prevent the artery from becoming blocked again.
Analyzing records from more than 15,600 patients in British Columbia implanted with either type of stent between 2004 and 2006, Cruden and his colleagues also found that those who didn't promptly fill their blood-thinner prescriptions were twice as likely to have a heart attack or die of any cause within two years.
Dr. Alpesh Shah, an interventional cardiologist at Houston Methodist Hospital in Texas, said the research emphasizes the need to educate patients about the critical importance of following doctors' recommendations just after stent surgery.
"A person coming in for a stent usually spends a night in the hospital and goes home the next morning," explained Shah, who wasn't involved in the study. "Then they may not see their physician for two to three weeks. In that period . . . realizing the value of every drug that has been prescribed sometimes gets lost."
Cruden suggested that all stent patients be discharged from the hospital with enough blood-thinning medicine to last for the first month post-surgery.
"In the United Kingdom, we routinely discharge patients with a supply of anti-platelet drugs to cover the immediate 'at-risk' period following stent implantation," he said. "One month would seem like a sensible starting point."
The U.S. National Heart, Lung, and Blood Institute offers more information on stents.
Posted: May 2014
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