Ischaemic heart disease

Why do some patients not receive dual antiplatelet therapy after stenting?

Tuesday, 10 Mar 2020

One in ten patients undergoing PCI with stent implantation do not receive guideline-recommended dual antiplatelet therapy after their procedure, Australian research shows.

These patients may be at risk of stent thrombosis because dual antiplatelet therapy is superior to aspirin alone for preventing atherothrombotic events, said researchers from NSW.

A review of PBS data linked to Medicare PCI items (38306, 38312, 38318) for 2869 patients who underwent stenting in 2013-2014 found that 2592 (90%) were dispensed dual antiplatelet drugs (aspirin with clopidogrel, prasugrel or ticagrelor ) within 30 days of the procedure.

Writing in the MJA, study authors led by Dr Bejamin Hsu and colleagues from the University of NSW, Sydney, said cost barriers and PBS-hospital dispensing arrangements for some states may have been a factor in the underuse of antiplatelet therapy.

They noted that antiplatelet therapy was more frequently dispensed for concessional PBS beneficiaries who had PCI stenting. Since the maximum out‐of‐pocket cost for a PBS item was capped at $5.90 for concessional beneficiaries but $36.10 for general beneficiaries at the time of the study, general beneficiaries may have faced significant out‐of‐pocket costs barriers to using antiplatelet therapy in addition to the costs of health insurance and their procedure.

They also noted that antiplatelet therapy was less frequent among patients from NSW or the ACT compared to other states and territories.

In most states, Commonwealth-state agreements allow PBS‐subsidised medications to be dispensed to patients when they are discharged from hospital.

“NSW and the ACT, however, do not participate in this agreement; patients are discharged from public hospitals with unsubsidised medicines sufficient for only 2–7 days, after which they must visit a community doctor for prescribing of PBS‐subsidised medications. This inconvenience may contribute to the lower 30‐day dispensing rate in these jurisdictions,” they write.

“Why some patients undergoing PCI‐S are not receiving dual antiplatelet therapy directly after their procedure should be further investigated,” they concluded.

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