Potential unrecognised costs of clopidogrel pretreatment in acute coronary syndrome.
OBJECTIVE
To examine adherence in clinical practice to the American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations of observing a 5-day waiting period after clopidogrel administration before undergoing coronary artery bypass graft (CABG) surgery and to examine the costs of waiting.


METHODS
This retrospective study used a nationwide inpatient database (Solucient ACTracker) to identify patients who were admitted for acute coronary syndrome (ACS), and who had same-stay CABG. Cost of additional days of stay was estimated using regression analysis.


RESULTS
The recommended 5-day waiting was adhered to in 16.9% (n=3,809) of patients. The percentage of patients with ACS undergoing CABG surgery on day 0 was 14.6%. Adherence to the waiting was higher for teaching and rural hospitals; and in female and elderly patients and urgent admissions.


CONCLUSIONS
The recommended 5-day waiting for CABG surgery after clopidogrel treatment is poorly adhered to in clinical practice. This study was unable to determine specific reasons for the low adherence; however, there may be a compromise between the clinically urgent need for revascularisation and increased risk of bleeding, as well as economic costs associated with waiting. The cost of an additional hospital day in this group of patients was approximately £1,400 per day or £7,000 for 5 days. Thus, a full 5-day wait would have a significant economic impact on hospital costs.
Bae
Jay P
JP
Eli Lilly and Company, Indianapolis, IN, USA.
Dobesh
Paul P
PP
McCollam
Patrick L
PL
Khoynezhad
Ali
A
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*; D000368:Aged; D000572:American Heart Association; D001803:Blood Transfusion; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors; D014481:United States
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine