Key result
Early discontinuation of clopidogrel after drug-eluting stent placement was frequently driven by misunderstanding the intended treatment duration and gaps in transition to primary care.
Observational (n=22)
Early discontinuation of clopidogrel after DES implantation is often driven by misunderstandings of treatment duration and system-level care gaps rather than willful nonadherence.
Enhanced education on clopidogrel duration and care transitions may curb early discontinuation after DES; hypothesis-generating for adherence interventions.
BACKGROUND: Each day, patients make choices whether or not to take their prescribed medications. Previous research has shown that 1 in 7 myocardial infarction (MI) patients discontinued thienopyridines within 1 month of receiving a drug-eluting stent (DES) with serious consequences. This qualitative research study explored in depth the clopidogrel-taking behavior among DES-treated patients who quit taking clopidogrel 1 month after treatment and those who continued therapy. METHODS: Sequential patients from a prospective MI registry who reported discontinuing clopidogrel within 30 days of DES treatment (N = 11) were matched with continuers (N = 11). Both groups underwent detailed qualitative phone interviews. Coding and thematic representation using directed qualitative content analysis by 3 PhD researchers was done. RESULTS: Patients were 41-77 years old and the majority was Caucasian and male. Multiple barriers were described by discontinuers that were not reported by continuers. The most frequently cited barrier was misunderstanding the intended duration of treatment. Discontinuers also described system weaknesses that contributed to early discontinuance such as gaps in the transition to primary care. CONCLUSIONS: While premature discontinuation of a prescribed therapy is viewed by clinicians as a willful disregard for medical advice, early stopping of clopidogrel is influenced greatly by processes of care and system issues.
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Carole Decker (2008) conducted an observational in Myocardial infarction treated with a drug-eluting stent (n=22). Early discontinuation of clopidogrel vs. Continuation of clopidogrel was evaluated on Barriers to clopidogrel continuation. Early discontinuation of clopidogrel after drug-eluting stent placement was frequently driven by misunderstanding the intended treatment duration and gaps in transition to primary care.