Clopidogrel-taking behavior by drug-eluting stent patients: Discontinuers versus continuers
Carole Decker1, Linda Garavalia2, Brian Garavalia1, John A Spertus1
1Mid America Heart Institute, Saint Luke’s Hospital, Kansas City, MO, USA; 2Department of Psychology, University of Missouri, Kansas City, MO, USA
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.
Keywords: medication discontinuance, drug-eluting stent post-care, myocardial infarction
This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php
Other article by this author:
Decker C, Garavalia L, Garavalia B, Simon T, Loeb M, Spertus J, Daniel WC
Published Date: 13 June 2012
Readers of this article also read:
Managing treatment fatigue in patients with multiple sclerosis on long-term therapy: the role of multiple sclerosis nurses
Crawford A, Jewell S, Mara H, McCatty L, Pelfrey R
Published Date: 19 August 2014
Clinical advances in the management of chronic myelogenous leukemia: focus on bosutinib and patient considerations
Sweet K, Pinilla-Ibarz J, Zhang L
Published Date: 8 July 2014
Miyazaki T, Tokimura F, Tanaka S
Published Date: 8 April 2014
Adherence to intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine and outcome of pregnancy among parturients in South East Nigeria
Onyebuchi AK, Lawani LO, Iyoke CA, Onoh CR, Okeke NE
Published Date: 7 April 2014
Takeda Y, Tsujino K, Kijima T, Kumanogoh A
Published Date: 21 March 2014
Titanate nanowire scaffolds decorated with anatase nanocrystals show good protein adsorption and low cell adhesion capacity
Ding XL, Yang XQ, Zhou L, Lu HB, Li SB, Gao Y, Lai CH, Jiang Y
Published Date: 7 February 2013
Effectiveness of simple balancing training program in elderly patients with history of frequent falls
Kuptniratsaikul V, Praditsuwan R, Assantachai P, Ploypetch T, Udompunturak S, Pooliam J
Published Date: 6 May 2011
Simultaneous, noninvasive, and transdermal extraction of urea and homocysteine by reverse iontophoresis
Congo Tak-Shing Ching, Tzong-Ru Chou, Tai-Ping Sun, et al
Published Date: 20 February 2011
Jun Wang, Yue Chen, Baoan Chen, et al
Published Date: 13 October 2010
Visualization of gold and platinum nanoparticles interacting with Salmonella Enteritidis and Listeria monocytogenes
Ewa Sawosz, André Chwalibog, Jacek Szeliga, et al.
Published Date: 30 August 2010