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Related Experiment Videos

Concordance between clopidogrel use and prescribing guidelines.

P A Kubler1, P I Pillans, M C Marrinan

  • 1Department of Clinical Pharmacology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4102, Australia. paul_kubler@health.qld.gov.au

Internal Medicine Journal
|December 22, 2004
PubMed
Summary

Clopidogrel prescribing often deviates from guidelines, with many patients receiving it inappropriately or for extended durations not supported by data. Concomitant aspirin use was also frequently missed when indicated.

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Area of Science:

  • Cardiology
  • Pharmacoeconomics
  • Clinical Pharmacy

Background:

  • Clopidogrel is an antiplatelet medication used for secondary prevention of vascular events.
  • Its cost-effectiveness compared to aspirin remains uncertain despite similar efficacy and safety profiles.
  • Current prescribing practices require evaluation against established guidelines.

Purpose of the Study:

  • To assess adherence to Pharmaceutical Benefits Scheme and hospital guidelines for clopidogrel prescribing.
  • To evaluate the intended duration of clopidogrel therapy and its alignment with published evidence.
  • To identify potential areas for improved prescribing and cost-effectiveness.

Main Methods:

  • A cross-sectional study involving 100 patients at a metropolitan hospital.

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  • Data collection through patient interviews and medical chart reviews.
  • Assessment of clopidogrel appropriateness based on prescribing guidelines and clinical indications.

    • Main Results:

    • Clopidogrel was primarily prescribed for ischemic heart disease (60%) and post-percutaneous coronary intervention (34%).
    • A significant number of patients (29%) received clopidogrel outside of established guidelines.
    • Inappropriate omission of concomitant aspirin therapy occurred in 23% of patients.
    • Many patients were prescribed indefinite clopidogrel therapy, exceeding evidence-based durations.

    Conclusions:

    • Significant discordance exists between clopidogrel use and current prescribing guidelines.
    • While most uses (71%) were for valid indications, off-guideline prescribing was common.
    • Inappropriate aspirin omission and prolonged clopidogrel treatment durations were noted, impacting potential cost-effectiveness.