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Current perspectives on British use of adjunctive therapies during coronary interventions
N Swanson1, K Hogrefe, A Stephens Lloyd
1Cardiology Clinical Sciences Wing, Glenfield Hospital, Leicester LE3 9QP, UK. ns56@le.ac.uk
Insights
British interventional cardiologists
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Adjunctive therapies like clopidogrel, ticlopidine, abciximab, and heparin are common in interventional cardiology.
- Assessing current UK practices for these agents against evidence is crucial.
Purpose of the Study:
- To evaluate the contemporary use of antiplatelet and anticoagulant agents in UK interventional cardiology.
- To compare current British usage patterns with the established evidence base.
Main Methods:
- A structured questionnaire was distributed to UK interventional cardiology consultants.
- Data collection occurred between August and October 1999, focusing on peri-procedural drug use.
Main Results:
- 68% of consultants responded.
- Abciximab use averaged 8.3%; 82% used clopidogrel in stented patients.
- Heparin (≥10000 IU) was routinely used by 53%; dosages varied significantly.
Conclusions:
- Observed usage patterns deviate from published evidence.
- British interventionists employ varied strategies, with abciximab seemingly used reactively.
- Practices suggest a divergence from evidence-based guidelines in adjunctive therapy selection.
Background:
Interventional techniques are commonly performed with adjunctive therapy including clopidogrel, ticlopidine, abciximab and heparin. We wished to assess the current British use of antiplatelet and anticoagulant agents as adjunctive therapies in interventional cardiology in the light of the available evidence base regarding their usage.
Methods:
A simple structured questionnaire was sent between August and October 1999 to all interventional cardiology consultants working in the UK regarding their usage of abciximab (ReoPro), heparin, clopidogrel (Plavix) and ticlopidine (Ticlid) peri-procedurally.
Results:
68% of consultants responded over the next 4 months, with many replying jointly for a centre rather than individually. Average abciximab use was 8.3% of interventional cases. Eighty-two percent of clinicians used clopidogrel in stented patients. Exact dosages varied considerably. Fifty-three percent of clinicians gave 10000 IU or more of heparin routinely.
Conclusions:
These figures are not in line with the published evidence and British interventionists appear to have adopted various strategies to target the use of these agents. In particular, abciximab appears to be being administered reactively, as and when problems arise in the catheterisation lab.