Delaying Anti-Clotting Rx Risks Stent Patients' Lives

Heart patients with stents improved survival odds by filling anticlotting prescriptions on time

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Typically, a patient who receives a stent to open a clogged blood vessel will be prescribed an anti-clotting medication. Taking these prescriptions as directed can be a lifesaver.

With atherosclerosis, blood vessels become narrowed and blocked as a substance called plaque builds up in artery walls. If the condition is advanced, a patient may have a stent (a small mesh tube) placed in the artery to restore blood flow.

Stents increase the risk of developing a blood clot. To prevent clots from forming in the stent, doctors may prescribe the blood thinner clopidogrel.

A new study has found that patients who delayed filling this prescription upon leaving the hospital faced a higher likelihood of dying or having a heart attack.

"Don’t put off filling anti-clotting prescriptions."

Nicholas Cruden, PhD, a consultant cardiologist at the Royal Infirmary of Edinburgh in the United Kingdom, led this analysis of 15,629 individuals in British Columbia, Canada who had received stents between 2004 and 2006.

Patients included those who had bare metal stents (with no special coating) and those with drug-eluting stents (coated with a medication that is slowly released to prevent scar tissue growth in the artery lining).

Those with bare metal stents are advised to take clopidogrel (brand name Plavix) and aspirin for a month after the procedure, while the same regimen is recommended for six to 12 months to patients with drug-eluting stents.

Delays in filling prescriptions upon hospital discharge are common, according to Dr. Cruden and his colleagues. They observed that putting off filling a prescription, however, may prove to be deadly.

About three out of 10 patients did not fill their clopidogrel prescription within three days of leaving the hospital.

Compared to those who filled them right away, as directed, those who delayed increased their health risks. Their likelihood of having a heart attack within a month was three times greater, and their odds of dying from any cause within a month were five times greater. Their likelihood of having a heart attack or dying from any cause within two years doubled.

"This study highlights the importance of ensuring patients have access to medications as soon as they leave the hospital," Dr. Cruden said in a press release. "Even a delay of a day or two was associated with worse outcomes."

He added that giving patients enough medicine for the first month or so after they leave the hospital, which is the highest-risk period, could help save lives and reduce the likelihood of heart attack.

Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, Texas, told dailyRx News, "Since these blood thinning medications can mean the difference between life and death, or between a normal life and a life of chronic disability, it's crucial that patients take them as prescribed after a heart procedure. The risk of a blood clot causing a sudden heart blockage is not just theoretical. It happens, and it can be devastating."

This study was published May 28 in the Journal of the American Heart Association. This work was supported by the Victoria Heart Institute Foundation in British Columbia, Canada.

Review Date: 
May 28, 2014
Last Updated:
June 5, 2014