Clopidogrel compliance following drug-eluting stent implanation

Project number: 
09-006
Approval date: 
Tuesday, December 21, 2010
Principal Investigator: 
Carere,Ronald
Institution: 
University of British Columbia (UBC)
Funding Agency: 
not grant funded
Datasets requested: 
Hospital Separations (BC Ministry of Health)
Deaths (BC Vital Statistics Agency)
PharmaNet
Research objective: 

Introduced in the 1990s, bare metal coronary stent (BMS) implantation revolutionized percutaneous coronary intervention by reducing abrupt vessel closure as well as recoil and restenosis following balloon angioplasty. 1 However, their use is associated with resenosis due to neo-intimal hyperplasia at the site of implantation. Drug-eluting coronary stents (DES) were successfully developed to address this problem and have reduced the need for target vessel revascularization by 50-70%. Despite their undoubted effectiveness cocnern has been raised in recent months over their safety, with recent data suggesting a small, but significantly increased risk of late thrombosis. Stent thrombosis is a serious clinical event associated with significant morality and morbidity. Although premature discontinuation of clopidogrel therapy has emerged as an independent risk factor for the development of stent thrombosis, our understanding of patient compliance with clopidogrel and the impact on clinical outcomes in the real world is limited. The objective of this study is to determine clopidogrel compliance following DES implantation and examine the relationship between compliance and clinical outcome.

Publications: 

Journal Publication

  • Cruden NL, Din JN, Janssen C, Smith R, Hilton JD, Klinke WP, Carere RG, Robinson SD, Siega AD. (2014) Delay in filling first clopidogrel prescription after coronary stenting is associated with an increased risk of death and myocardial infarction. J Am Heart Assoc. 2014 May 28;3(3):e000669. doi: 10.1161/JAHA.113.000669.
  • N. Cruden, J.N. Din, C. Janssen, S.D. Robinson, R. Smith, J.D. Hilton, W.P. Klinke, R.G. Carere, A. Della Siega (2013) Delay in filling a first prescription for clopidogrel after coronary stenting increases risk of death and myocardial infarction. European Heart Journal DOI: http://dx.doi.org/10.1093/eurheartj/eht310.P4815. (Abstract presented at ESC Scientific Sessions in 2013)
  • Cruden at el. Prolonged clopiodgrel use improves clinical outcomes following druf eluting but not bare metal stent implantation (2013) European Heart Journal http://dx.doi.org/10.1093/eurheartj/eht309.2589 (Abstract presented at ESC Scientific Sessions in 2013)
  • Din et al Non-adherence with clopidogrel after coronary stenting is associated with increased mortality and myocardial infarction.  J Am Coll Cardiol. 2013;61(10_S):. doi:10.1016/S0735-1097(13)61596. (Abstract presented at ACC Scientific Sessions in 2013)

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