Delay in filling first prescription for clopidogrel after coronary stenting increases risk of death and myocardial infarction
Bibliographic record
Abstract
Purpose: Current guidelines recommend adjuvant therapy with clopidogrel for 1 month following bare metal (BMS) and 6-12 months following drug eluting (DES) stent implantation. We investigated the effect of a delay in patients filling their first clopidogrel prescription after hospital discharge on clinical outcomes following coronary artery stenting. Methods: Hospital administrative, community pharmacy and cardiac revascularization data were linked to determine clopidogrel use and clinical outcomes for all patients receiving a coronary stent in British Columbia from 2004 - 2006 with follow-up to 5 years. Cox proportional hazard regression and propensity-matched analyses were performed to examine the effect of a delay of >3 days in filling a clopidogrel prescription following hospital discharge on clinical outcomes. Results: Of 15,629 patients, 3,599 patients received at least 1 DES whilst 12,030 received BMS alone. The median time to fill a clopidogrel prescription from hospital discharge was 1 day [IQR 1 to 3 days]. 1064 (30%) and 3758 (31%) patients in the DES and BMS groups respectively failed to fill a prescription within 3 days of discharge. Following regression analysis, a delay in filling a prescription for clopidogrel by >3 days was predictive of all-cause mortality (HR 1.9 95% CI [1.5-2.6] and HR 1.9; 95% CI [1.7-2.2]) and readmission for myocardial infarction (HR 1.7; 95% CI [1.3-2.2] and HR 1.5; 95% CI [1.3-1.8]) in the DES and BMS groups respectively. In propensity-matched analyses, patients who delayed filling their prescription had shorter survival (1722±386 days vs 1777±250 days, p=0.001 and 1658±472 days vs 1748±307 days, p<0.001) and were readmitted earlier with myocardial infarction (1705±423 vs 1748±331 days, p=0.029 and 1671±486 days vs 1736±360 days, p<0.001) in the DES and BMS groups respectively compared to those who filled their prescription within 3 days. Conclusions: A delay in patients filling their first prescription for clopidogrel following coronary stenting is common and is associated with serious adverse clinical outcomes, irrespective of stent type. Strategies to reduce delays in filling a prescription on discharge have the potential to improve clinical outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".