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Thienopyridine Therapy Risk Factors for Noncompliance

Purpose: To identify a patient with a drug-eluting stent who may not be compliant with thienopyridine therapy based on the study of Spertus et al.

Description

Spertus et al identified risk factors for poor compliance by a patient prescribed a thienopyridine following placement of a drug-eluted stent. Failure to continue thienopyridine therapy is associated with significant complications. The authors are from multiple universities participating in the Cardiovascular Outcomes Research Consortium (CORC).


 

Thienopyridines are antiplatelet agents that include clopidogrel and ticlopidine.

 

Parameters:

(1) age

(2) education

(3) marital status

(4) impact of cost on health care use

(5) comorbid diseases

(6) discharge instructions

(7) referral to cardiac rehabilitation

 

A patient is more likely to discontinue thienopyridine therapy if:

(1) older

(2) does not have a high school diploma

(3) not married

(4) avoids health care because of the cost

(5) had a history of anemia or cardiovascular disease before the stent was placed

(6) did not receive discharge instructions

(7) was not referred for cardiac rehabilitation

 

where:

• There is considerable overlap in the ages of the compliant (60 +/1 12) and noncompliant (64 +/- 13) groups.

• I wonder if cost of the medications would influence the decision to discontinue the drug.

 

A patient with one or more of these risk factors should be targeted for followup to improve compliance.

 


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Specialty

Objective

ICD-10