Telephone contact to improve adherence to dual antiplatelet therapy after drug-eluting stent implantation

Rinfret, Stéphane; Rodés-Cabau, Josep; Bagur, Rodrigo; Déry, Jean-Pierre; Dorais, Marc; Larose, Éric; Barbeau, Gérald; Gleeton, Onil; Nguyen, Can-Manh; Noël, Bernard; Proulx, Guy; Roy, Louis; Taillon, Isabelle; De Larochellière, Robert; Bertrand, Olivier F.
April 2013
Heart;Apr2013, Vol. 99 Issue 8, p562
Academic Journal
Background Many patients delay or interrupt dual antiplatelet therapy (DAT) after drug-eluting stent (DES) implantation, which increases the risk of stent thrombosis and death. Objective To test the hypothesis that simple telephone contact made by nurses would improve adherence to and persistence of DAT. Design Randomised controlled trial. Patients and intervention A total of 300 patients (mean±SD 64±10 years, 73% male) were recruited immediately after DES implantation performed between June 2009 and June 2010. The last patient recruited reached the 1-year follow-up time point in June 2011. Patients were randomised to one of two groups: intervention, with four telephone follow-ups, versus a control group. In the intervention group, phone calls were made within 7 days of the DES implantation and at 1, 6 and 9 months to support drug adherence. Control patients were followed as per usual clinical practice. Pharmacy data were collected to assess drug prescription filling and refill. Setting Tertiary care university cardiovascular centre and community. Main outcome measures The primary end point was the proportion of days covered with aspirin and clopidogrel over the year after discharge as assessed by pharmacy refill data. Secondary outcome measures included persistence of aspirin and clopidogrel treatment, defined as no gaps longer than 14 days during follow-up. Results Most patients (73%) underwent DES implantation in the context of an acute coronary syndrome. All patients had drug insurance cover, either from the public plan (59%) or through private plans (41%). Complete pharmacy follow-up data were available for 96% of the cohort. At 12 months, median scores (25th-75th centile) for adherence to aspirin and clopidogrel were 99.2% (97.5-100%) and 99.3% (97.5-100%), respectively, in the intervention group compared with 90.2% (84.2- 95.4%) and 91.5% (85.1-96.0%), respectively, in the control group (p<0.0001 for aspirin and clopidogrel). Patients in the intervention group were significantly more persistent in the aspirin and clopidogrel treatment than those in the control group. For clopidogrel, 87.2% of patients in the intervention group were still persistent at 12 months compared with only 43.1% in the control group (p<0.0001). Conclusions A simple approach of four telephone calls to patients after DES implantation significantly improved 1-year drug adherence to near-perfect scores. Persistence of DAT was also significantly improved by the intervention.


Related Articles

  • CORRECTION.  // JAMA: Journal of the American Medical Association;6/2/2015, Vol. 313 Issue 21, p2185 

    Corrections are presented for the articles "Community-Wide Cardiovascular Disease Prevention Programs and Health Outcomes in a Rural County, 1970-2010" in the January 13, 2015, issue and "Antiplatelet Therapy Duration Following Bare Metal or Drug-Eluting Coronary Stents: The Dual Antiplatelet...

  • Clopidogrel a CHARISMAtic choice in CVD care.  // PharmacoEconomics & Outcomes News;10/3/2009, Issue 588, p1 

    The article discusses the effects of clopidogrel-aspirin combination to cardiovascular disease (CVD) patients. According to U.S.-based researchers, adding clopidogrel to aspirin as secondary prevention for patients with CVD appears to increase life expectancy. They conducted an evaluation of...

  • Harvard Clinical Research Institute Successfully Completes Randomization in the DAPT Study.  // Biomedical Market Newsletter;8/7/2012, Vol. 21, p1 

    The article provides information on the completion of the randomization in the dual antiplatelet therapy (DAPT) by the Harvard Clinical Research Institute (HCRI). It also informs that DAPT Study is a four-year clinical trial investigating the duration of DAPT which is a combination of aspirin...

  • Perioperative Antiplatelet Therapy. CHASSOT, PIERRE GUY; MARCUCCI, CARLO; DELABAYS, ALAIN; SPAHN, DONAT R. // American Family Physician;12/15/2010, Vol. 82 Issue 12, p1484 

    Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular disease. Clopidogrel therapy is mandatory for six weeks after placement of bare-metal stents, three to six months after myocardial infarction, and at least 12 months after placement of...

  • Perioperative management of antiplatelet therapy. Oprea, A. D.; Popescu, W. M. // BJA: The British Journal of Anaesthesia;Dec2013, Vol. 111, pi3 

    Worldwide, cardiovascular events represent the major cause of morbidity and mortality. A key role in the pathogenesis of these events is played by platelets. Interventional procedures, with placement of coronary and vascular stents, often represent the preferred therapeutic strategy....

  • Results of the PARIS registry Reported at TCT 2011.  // Biomedical Market Newsletter;11/14/2011, Vol. 21, p788 

    The article discusses the results of the PARIS Registry multicenter study at the 23rd annual Transcatheter Cardiovascular Therapeutics symposium by the Cardiovascular Research Foundation. It examined the modes of nonadherence to dual antiplatelet therapy (DAPT) after coronary intervention. It...

  • Role of insulin-like growth factor 1 in stent thrombosis under effective dual antiplatelet therapy. Arif Yalcin, Ahmet; Topuz, Mustafa; Biyik, Ismail; Faruk Akturk, Ibrahim; Celik, Omer; Isıksacan, Nilgun; Yalcın, Burce; Birant, Ali; Uzun, Fatih // Advances in Interventional Cardiology;2014, Vol. 10 Issue 4, p242 

    Introduction: Accumulating evidence now indicates that insulin-like growth factors (IGF) and their regulatory proteins are growth promoters for arterial cells and mediators of cardiovascular diseases. Aim: We hypothetised that IGF-1 levels could play a role in the development of stent thrombosis...

  • OPTIMA Tacrolimus-eluting Stent: A Twelve-month Clinical Follow up with Two Different Periods of Dual Antiplatelet Therapy; 2-month vs. 6-month Approach. Aslanabadi, Nasser; Separham, Ahmad; Beheshti, Reza; Ghaffari, Samad; Sohrabi, Bahram // Journal of Cardiovascular & Thoracic Research;2012, Vol. 4 Issue 3, p81 

    Introduction: There are limited data comparing long-term eficacy and safety of OPTIMA tacrolimus-eluting stent (TES) with Dual Antiplatelet Therapy (DAT) in daily practice. Therefore, we evaluated the safety and performance of OPTIMA TES with 2 or 6-month dual antiplatelet therapy in a 12-month...

  • Cardiovascular risks of stopping antiplatelet therapy before non-cardiac surgery for patients with coronary stents. Maddox, Thomas M. // Evidence Based Medicine;Aug2012, Vol. 17 Issue 4, p122 

    The article provides an overview of the study conducted by Albaladejo and colleagues for identifying cardiovascular (CV) risks associated with the discontinuation of antiplatelet therapy before non-cardiac surgery in patients suffering from coronary stents. Interruption of antiplateley therapy,...

  • Antiplatelet Therapy Discontinuation and the Risk of Serious Cardiovascular Events after Coronary Stenting: Observations from the CREDO-Kyoto Registry Cohort-2. Watanabe, Hirotoshi; Morimoto, Takeshi; Natsuaki, Masahiro; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Yamaji, Kyohei; Ando, Kenji; Shizuta, Satoshi; Shiomi, Hiroki; Tada, Tomohisa; Tazaki, Junichi; Kato, Yoshihiro; Hayano, Mamoru; Abe, Mitsuru; Tamura, Takashi; Shirotani, Manabu; Miki, Shinji; Matsuda, Mitsuo; Takahashi, Mamoru // PLoS ONE;Apr2015, Vol. 10 Issue 4, p1 

    Relation of antiplatelet therapy (APT) discontinuation with the risk of serious cardiovascular events has not been fully addressed yet. This study is aimed to evaluate the risk of ischemic event after APT discontinuation based on long-term APT status of large cohort. In the CREDO-Kyoto Registry...


Read the Article


Sign out of this library

Other Topics