Factors Affecting Delay in Filling Prescriptions for Dual Antiplatelet Therapy After Coronary Stenting

摘要

Dual antiplatelet therapy (DAPT) is critical in preventing stent thrombosis after percutaneous coronary intervention (PCI). Delays in DAPT after PCI have been associated with stent thrombosis, reinfarction, and death. Cases of death, stent thrombosis, and reinfarction at our institution have been attributed to patient delays in accessing DAPT on discharge after PCI. We sought to determine the proportion of patients that delay filling their discharge prescription for DAPT after PCI and factors that influence delays in DAPT prescription-filling. We reviewed all patients who received PCI at St Paul's Hospital from April 1, 2015 to April 1, 2016 and determined the date of the first prescription filling of a P2Y12 antiplatelet agent after hospital discharge. The primary outcome was proportion of patients who delay filling their DAPT discharge prescription. Logistic regression analysis was performed to determine the relationship of various factors with delays in DAPT-filling. Six hundred fifty-one patients were included in the final analysis. Age, sex, and provincial drug coverage status were not associated with delays in DAPT prescription-filling. Distance of patient's residence to St Paul's Hospital was associated with a significant delay in DAPT prescription filling (adjusted odds ratio, 1.90; 95% confidence interval, 1.11- 3.22). Hospital discharge processes to ensure timely access to DAPT after PCI should be established.