Clopidogrel Prescription & Mortality Study

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Questions and Answers

What type of statistical method was used to conduct the adjustment for differences between the groups?

Kaplan-Meier Analysis

Linear Regression Analysis

Cox Proportional Hazards Modelling (correct)

Multivariable Logistic Regression

What is a primary concern regarding the prognostic factors between the exposed and control groups?

Differences in the number of chronic conditions were noted. (correct)

There was a high number of patients in the study.

Patients had similar risk factors as determined by p-values.

All patients received the same type of medication.

What is a potential outcome of residual confounding in the context of this study?

Reduction of bias in the analysis.

Misleading associations between the intervention and outcome. (correct)

Increased statistical power.

Improved validity of the findings.

What was the outcome measured in the study regarding clopidogrel treatment?

All-cause death Signup and view all the answers

What was the baseline risk of death for participants who did not fill their prescription for clopidogrel?

6.9% Signup and view all the answers

What was the absolute risk reduction (ARR) of death for participants without any delay in prescription filling?

4.0% Signup and view all the answers

Which group had a higher absolute event rate during the follow-up period?

Participants who had delayed filling their prescription Signup and view all the answers

What does NNH stand for in the context of risk assessment in drug therapies?

Number Needed to Harm Signup and view all the answers

What was the relative risk (RR) of death for patients treated with clopidogrel according to the reported figures?

2.38 Signup and view all the answers

Why is it challenging to apply the results of the study to different patient populations?

Differences in baseline risk are not clearly defined. Signup and view all the answers

What is the relative risk increase for patients who filled a prescription for clopidogrel with a delay compared to those without a delay?

55% Signup and view all the answers

What hazard ratio indicates the increased risk of mortality for patients who did not fill a clopidogrel prescription compared to those who filled without delay?

HR 1.70 Signup and view all the answers

Which of the following relative risks indicates the increased risk of death for patients who filled with a delay compared to filling without delay?

1.55 Signup and view all the answers

What factor is considered when assessing the precision of risk estimates in the study?

The width of the confidence interval Signup and view all the answers

Study Notes

Study Design

This study investigated the association between delayed or absent filling of clopidogrel prescriptions after percutaneous coronary intervention (PCI) and all-cause death within a year.
The study compared three groups: patients who did not fill a clopidogrel prescription, those who filled with a delay, and those who filled without a delay.

Key Findings

Increased Risk of Death:
- Patients who delayed filling their clopidogrel prescription after PCI had a higher risk of mortality compared to those who filled without a delay (hazard ratio [HR] 1.35).
- Patients who did not fill a clopidogrel prescription had a significantly higher risk of mortality compared to those who filled without a delay (HR 1.70).
Relative Risk Increase:
- Delay vs. No Delay: 55% relative risk increase
- No Rx vs. No Delay: 138% relative risk increase

Limitations

Residual Confounding:
- The study acknowledged potential confounding factors that could influence the results, such as differences in patient characteristics and history of cardiovascular disease.
- While statistical adjustment was performed, the authors did not provide sufficient information regarding the specific variables adjusted for, which might have led to residual confounding.
Immortal Time Bias:
- The study design introduced immortal time bias as patients could not have died before filling their clopidogrel prescription.
- This could have overestimated the risk associated with delayed or absent prescription fills.

Clinical Significance

The study suggests that timely filling of clopidogrel prescriptions post PCI is beneficial for reducing mortality.
However, the authors acknowledge the potential limitations and emphasize that further research is needed to confirm these findings.

Additional Considerations

The study did not explore the specific mechanisms behind the observed associations, such as the potential impact of delayed treatment on platelet aggregation and blood clotting.
The authors did not provide a detailed analysis of the benefits and risks associated with clopidogrel therapy beyond the observed mortality risks.

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Description

This quiz explores the findings of a study on the impact of clopidogrel prescription filling after PCI on mortality rates. It compares patients who delayed filling their prescriptions versus those who filled on time, highlighting significant risks involved. Understand the implications of these findings and the associated risks detailed in the study.