Survey of clopidogrel use in a teaching hospital

Aim: To develop guidelines for clopidogrel prescribing and survey its use to ascertain the need for changes in prescribing patterns. Method: Guidelines were developed after a literature review. Prescribing patterns were assessed by a cross sectional survey which investigated the therapy of inpatients identified taking clopidogrel at a teaching hospital over a 2-month period. Measures of concordance were indications for clopidogrel, contraindications to NSAIDs, timing and range of clopidogrel dosage and associated use of aspirin. Results: Data were collected from 69 patients. 29 (42%) were taking clopidogrel for secondary prevention of ischaemic heart disease - 14 for appropriate indications. 23 (33%) were given clopidogrel before and/or following percutaneous coronary intervention - 11 had an appropriate combined aspirin and clopidogrel loading dose, and 20 had appropriate combined long term therapy. 15 (22%) received clopidogrel for secondary prevention of cerebrovascular disease and 7/15 had appropriate indications. 2 (2.9%) patients with peripheral vascular disease and 1 (1.4%) with chronic atrial fibrillation were treated directly with clopidogrel. 3 (4.3%) patients had unknown indications. Conclusions: A large proportion of clopidogrel prescribing did not have a good evidence base. For safety and economic reasons, prescribers need to be made aware of current evidence and recommendations.Paul Armenores, Stephanie L Wiltshire,Anne L Tonkin,Sepehr Shaki