Clopidogrel-taking behavior by drug-eluting stent patients: Discontinuers versus continuers.
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.
Decker
Carole
C
Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO, USA;
Garavalia
Linda
L
Garavalia
Brian
B
Spertus
John A
JA