{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T02:44:35Z","timestamp":1761101075253,"version":"3.38.0"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2012,1]]},"abstract":"<jats:sec><jats:title>Background\u2014<\/jats:title><jats:p>Clopidogrel use after drug-eluting stent (DES) coronary artery implantation is essential for the prevention of early in-stent thrombosis, but clopidogrel use among older DES recipients has not been widely studied. We sought to identify characteristics associated with failure to fill a clopidogrel prescription and to examine the relationship between a clopidogrel prescription fill and hospitalization for acute myocardial infarction (AMI) or death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results\u2014<\/jats:title><jats:p>This study was a retrospective analysis of administrative data (20% sample) of 15 996 Medicare Part D enrollees who received a DES in 2006 to 2007. We modeled the adjusted probability and odds of clopidogrel prescription fill within 7 and 90 days of discharge and its association with AMI hospitalization or death. Of the study sample, 19.7% did not fill a clopidogrel prescription within 7 days of discharge, falling to 13.3% by day 90. The adjusted probability of filling a clopidogrel prescription within 7 or 90 days of discharge was lower for patients with dementia (20.2% less likely; 95% CI, 10.4%\u201330.1%), depression (10.7% less likely; 95% CI, 6.9%\u201314.5%), age &gt;84 years compared to age 65 to 69 years (10.6% less likely; 95% CI, 8.6%\u201312.7%), black race (6.6% less likely; 95% CI, 4.2%\u20139.0%), intermediate levels of medication cost share (5.2% less likely; 95% CI, 2.9%\u20137.6%), and female sex (3.3% less likely; 95% CI, 2.1%\u20134.5%). It was higher for patients initially hospitalized for an AMI (12.5% more likely; 95% CI, 11.3%\u201313.6%). Failure to fill a clopidogrel prescription within 7 days of discharge was associated with a higher adjusted odds ratio of death during days 8 to 90 (2.44; 95% CI, 1.76\u20133.38) but was not associated with an increased risk of hospitalization for AMI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions\u2014<\/jats:title><jats:p>One in 5 patients failed to fill a prescription for clopidogrel at 7 days after DES placement, and 1 in 7 failed to do so by 3 months. Individual characteristics available at the time of hospital discharge were associated with a clopidogrel prescription fill. Those characteristics most strongly associated with nonadherence, including age &gt;84 years, not having an AMI, depression, and dementia, may guide clinicians and health systems seeking to target this high-risk population and improve health outcomes after percutaneous coronary intervention.<\/jats:p><\/jats:sec>","DOI":"10.1161\/circoutcomes.111.962704","type":"journal-article","created":{"date-parts":[[2011,12,7]],"date-time":"2011-12-07T06:31:27Z","timestamp":1323239487000},"page":"103-112","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Clopidogrel Use and Early Outcomes Among Older Patients Receiving a Drug-Eluting Coronary Artery Stent"],"prefix":"10.1161","volume":"5","author":[{"given":"Gregory A.","family":"Roth","sequence":"first","affiliation":[{"name":"From the Division of Cardiology, University of Washington, Seattle, WA (G.A.R.), and Dartmouth Medical School (N.E.M., W.Z., J.S.) and Dartmouth College (J.S.), Hanover, NH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy E.","family":"Morden","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Washington, Seattle, WA (G.A.R.), and Dartmouth Medical School (N.E.M., W.Z., J.S.) and Dartmouth College (J.S.), Hanover, NH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiping","family":"Zhou","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Washington, Seattle, WA (G.A.R.), and Dartmouth Medical School (N.E.M., W.Z., J.S.) and Dartmouth College (J.S.), Hanover, NH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Malenka","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Washington, Seattle, WA (G.A.R.), and Dartmouth Medical School (N.E.M., W.Z., J.S.) and Dartmouth College (J.S.), Hanover, NH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Skinner","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Washington, Seattle, WA (G.A.R.), and Dartmouth Medical School (N.E.M., W.Z., J.S.) and Dartmouth College (J.S.), Hanover, NH."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","unstructured":"Hospital Medicare Payment And Volume Measures - National Average. http:\/\/data.medicare.gov\/d\/ux4p-jnm7. 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