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October 22, 2008New England Journal of MedicineOpen Access

Cardiovascular Outcomes after a Change in Prescription Policy for Clopidogrel

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Key result

A limited-use policy for clopidogrel significantly decreased the 1-year composite cardiovascular outcome compared to a prior-authorization policy (11% vs 15%, P=0.02).

Why the study?

Does a less restrictive prescription policy for clopidogrel improve cardiovascular outcomes in patients 65 years or older undergoing PCI with stenting after acute myocardial infarction?

Population

Patients 65 years of age or older with acute myocardial infarction who underwent percutaneous coronary…

Comparison

Less restrictive, limited-use policy for… vs Prior-authorization policy for clopidogrel…

Design

Cohort

Follow-up

1 year

Authors

CJCynthia A. JackeviciusJTJack V. TuVDV. Demers

Discussion

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Member takes

Overview

May support less restrictive clopidogrel policies after AMI PCI; observational data leave open need for randomized confirmation.

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Does a less restrictive prescription policy for clopidogrel improve cardiovascular outcomes in patients 65 years or older undergoing PCI with stenting after acute myocardial infarction?

P
Population
Older adults (≥65 years) with acute myocardial infarction undergoing PCI with stenting in Ontario, Canada, evaluated over a 1-year follow-up period.
E
Exposure
Less restrictive, limited-use policy for clopidogrel prescription (pharmacy-benefits program).
C
Comparator
Prior-authorization policy for clopidogrel prescription.
O
Outcome
Composite rate of death, recurrent acute myocardial infarction, PCI, and coronary-artery bypass grafting at 1 year, with adjustment for sex and age.composite

Main Result

Absolute Event Rate: 11% vs 15%

p-value: p=0.02

Removing prior-authorization barriers for clopidogrel after PCI for acute myocardial infarction significantly improved timely access to the medication and reduced 1-year adverse cardiovascular outcomes.

Cite This Study

Jackevicius et al. (2008) conducted an observational in Acute myocardial infarction undergoing PCI with stenting. Limited-use policy for clopidogrel vs. Prior-authorization policy was evaluated on Composite rate of death, recurrent acute myocardial infarction, PCI, and coronary-artery bypass grafting at 1 year (p=0.02). A limited-use policy for clopidogrel significantly decreased the 1-year composite cardiovascular outcome compared to a prior-authorization policy (11% vs 15%, P=0.02).

synapsesocial.com/papers/6a961879438650a232c75df9https://doi.org/10.1056/nejmsa0803410
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Restrictive access to clopidogrel and mortality following coronary stent implantation2008 · 27 citations
  2. 2Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation2006 · 873 citations
  3. 3Prevalence, Predictors, and Outcomes of Premature Discontinuation of Thienopyridine Therapy After Drug-Eluting Stent Placement2006 · 857 citations
  4. 4Prior-Authorization Programs for Controlling Drug Spending2004 · 32 citations
  5. 5Effectiveness and Safety of Drug-Eluting Stents in Ontario2007 · 388 citations