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January 1/8, 2019

Medication Co-payment Vouchers, Adherence With Antiplatelet Therapy, and Adverse Cardiovascular Events After Myocardial Infarction

Author Affiliations
  • 1Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California
  • 2ICES, Toronto, Ontario, Canada
  • 3Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
  • 4Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 5University Health Network, Toronto, Ontario, Canada
  • 6Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
JAMA. 2019;321(1):37-39. doi:10.1001/jama.2018.20396

Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (such as clopidogrel) is recommended for 1 year after myocardial infarction (MI) to reduce the risk of major adverse cardiovascular events (MACE), with practice guidelines supporting ticagrelor or prasugrel over clopidogrel because of improved clinical outcomes.1 However, the benefit of dual antiplatelet therapy in improving clinical outcomes can only occur if patients take their medications. Yet medication adherence is suboptimal after MI, with a report from 2008 indicating that 1 in 4 patients did not fill their initial cardiac medication prescriptions in the first month after MI, which is associated with higher mortality and cardiovascular events.2 Recent studies estimate that the average proportion of time a patient takes a prescribed P2Y12 inhibitor over 1 year ranges from a high of 76% for clopidogrel to a low of 68% for ticagrelor after stent implantation.3