Pattern of clopidogrel use in hospitalized patients receiving percutaneous coronary interventions.

Abstract

PURPOSE:

The pattern of clopidogrel loading in patients who had undergone percutaneous coronary intervention (PCI) was studied in a retrospective analysis of clinical records.

METHODS:

A database of deidentified electronic medical records from hospitals and hospital-affiliated outpatient facilities throughout the United States was analyzed for PCI patients with or without a diagnosis of acute coronary syndrome (ACS) who received clopidogrel loading doses of > or =300 mg between 48 hours before and 6 hours after PCI. A high dose was defined as > or =600 mg, and pretreatment was defined as more than 6 hours before PCI for 300-599 mg and 2 or more hours before PCI for > or =600 mg.

RESULTS:

Among 6253 PCI patients who met the criteria, there were 2331 with a diagnosis of ACS (ACS-PCI) and 3922 without an ACS diagnosis (elective PCI). Of the ACS-PCI patients, 1359 had ST-segment elevation myocardial infarction (STEMI) and 972 had unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI). A majority of ACS-PCI patients (57%) received a > or =600-mg loading dose, 34% received a 300-mg loading dose, and the rest received a loading dose between 300 and 600 mg. Loading consisted of a single bolus in 75% of patients, two doses in 21.5%, and three or more doses in 3.1%. The first dose was during or after PCI in 56% of the UA/NSTEMI group and in 71% of both the elective PCI and STEMI groups. Among the UA/NSTEMI group, only 33% met criteria for pretreatment.

CONCLUSION:

Reported practice patterns of clopidogrel administration before PCI for UA/NSTEMI were not consistent with evidence generated from published clinical trials and guidelines. Recommended pre-treatment with clopidogrel was frequently not practiced.

• Authors: Bonnie B Dean, Hsing-Ting Yu, Jay P Bae, Suzanne Fiske, Eric Meadows, Yan Xiong, Matthew F Emons
• Journal: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (Am J Health Syst Pharm) Vol. 67 Issue 17 Pg. 1430-7 (Sep 01 2010) ISSN: 1535-2900 [Electronic] England
• PMID: 20720242 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine

Topics

• Acute Coronary Syndrome (drug therapy)
• Adult
• Aged
• Aged, 80 and over
• Angina Pectoris (drug therapy)
• Angioplasty, Balloon, Coronary
• Clopidogrel
• Drug Utilization
• Electronic Health Records
• Female
• Hospitalization
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy)
• Perioperative Period
• Platelet Aggregation Inhibitors (administration & dosage, therapeutic use)
• Practice Guidelines as Topic
• Retrospective Studies
• Ticlopidine (administration & dosage, analogs & derivatives, therapeutic use)
• United States