Adherence to guidelines for the prescribing of double and triple combinations of antithrombotic agents
Background:To prevent cardiovascular complications, sometimes double and triple therapy with a vitamin K antagonist (VKA), clopidogrel and/or acetylsalicylic acid (ASA) are indicated. These combinations increase the patient’s risk of serious bleeding events. Therefore, adherence to clinical guidelin...
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| Veröffentlicht in: | European journal of preventive cardiology 2014-02, Vol.21 (2), p.231-243 |
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| container_title | European journal of preventive cardiology |
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| creator | Herwaarden, Margaretha F Warlé-Van Roukens, Monique Pop, Gheorghe AM Lamfers, Evert JP De Smet, Peter AGM Kramers, Cornelis |
| description | Background:To prevent cardiovascular complications, sometimes double and triple therapy with a vitamin K antagonist (VKA), clopidogrel and/or acetylsalicylic acid (ASA) are indicated. These combinations increase the patient’s risk of serious bleeding events. Therefore, adherence to clinical guidelines is of the utmost importance when these high-risk therapies are prescribed.
Methods:We performed a retrospective cohort study of 238 cases in a community pharmacy that were treated with a combination of VKA, clopidogrel and/or ASA between January 2006 and December 2009. Hospital records and community pharmacy records were used to obtain the indication(s), the duration of combination therapy, the presence of risk-increasing and risk-decreasing co-medications and any relevant co-morbidities. The cardiologists’ attitudes towards the prescribing of antithrombotic combinations and their self-reported adherence to guidelines were assessed by a brief questionnaire.
Results:We found there was no guideline-based indication for 22 of the 146 cases (14%) on ASA plus clopidogrel and 19 of the 82 cases (23%) on VKA plus ASA. Of the 238 cases given antithrombotic combination therapies, 77 (32%) were placed at an additional increased risk of serious gastrointestinal events, yet 43 (56%) of these did not receive adequate gastric protection. Out of the 19 of 60 cardiologists (32%) who responded to our questionnaire; 17 (90%) and 13 (68%) stated that a strict indication is very important when initiating therapy with ASA plus clopidogrel or ASA plus VKA, respectively.
Conclusions:There is room to further develop adherence to guideline-based prescribing of antithrombotic combination therapies and to improve prescription of gastric protection for patients receiving these high-risk combinations. |
| doi_str_mv | 10.1177/2047487312451253 |
| format | Article |
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Methods:We performed a retrospective cohort study of 238 cases in a community pharmacy that were treated with a combination of VKA, clopidogrel and/or ASA between January 2006 and December 2009. Hospital records and community pharmacy records were used to obtain the indication(s), the duration of combination therapy, the presence of risk-increasing and risk-decreasing co-medications and any relevant co-morbidities. The cardiologists’ attitudes towards the prescribing of antithrombotic combinations and their self-reported adherence to guidelines were assessed by a brief questionnaire.
Results:We found there was no guideline-based indication for 22 of the 146 cases (14%) on ASA plus clopidogrel and 19 of the 82 cases (23%) on VKA plus ASA. Of the 238 cases given antithrombotic combination therapies, 77 (32%) were placed at an additional increased risk of serious gastrointestinal events, yet 43 (56%) of these did not receive adequate gastric protection. Out of the 19 of 60 cardiologists (32%) who responded to our questionnaire; 17 (90%) and 13 (68%) stated that a strict indication is very important when initiating therapy with ASA plus clopidogrel or ASA plus VKA, respectively.
Conclusions:There is room to further develop adherence to guideline-based prescribing of antithrombotic combination therapies and to improve prescription of gastric protection for patients receiving these high-risk combinations.</description><identifier>ISSN: 2047-4873</identifier><identifier>EISSN: 2047-4881</identifier><identifier>DOI: 10.1177/2047487312451253</identifier><identifier>PMID: 22684153</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Aspirin - therapeutic use ; Attitude of Health Personnel ; Biological and medical sciences ; Bones, joints and connective tissue. Antiinflammatory agents ; Cardiology. Vascular system ; Clopidogrel ; Community Pharmacy Services ; Comorbidity ; Drug Interactions ; Drug Prescriptions ; Drug Therapy, Combination ; Drug Utilization Review - trends ; Female ; Fibrinolytic Agents - adverse effects ; Fibrinolytic Agents - therapeutic use ; Guideline Adherence - trends ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Heart ; Hemorrhage - chemically induced ; Hemorrhage - prevention & control ; Humans ; Male ; Medical sciences ; Middle Aged ; Netherlands ; Pharmacology. Drug treatments ; Platelet Aggregation Inhibitors - therapeutic use ; Practice Guidelines as Topic ; Practice Patterns, Physicians' - trends ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Surveys and Questionnaires ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use ; Vitamin K - antagonists & inhibitors</subject><ispartof>European journal of preventive cardiology, 2014-02, Vol.21 (2), p.231-243</ispartof><rights>The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-cd77bae0a95ebd8e2a4fd3fd11e12d0205759fe7ce6a65344baefbb88df6823</citedby><cites>FETCH-LOGICAL-c409t-cd77bae0a95ebd8e2a4fd3fd11e12d0205759fe7ce6a65344baefbb88df6823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2047487312451253$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2047487312451253$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21817,27922,27923,43619,43620</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28250297$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22684153$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Herwaarden, Margaretha F Warlé-Van</creatorcontrib><creatorcontrib>Roukens, Monique</creatorcontrib><creatorcontrib>Pop, Gheorghe AM</creatorcontrib><creatorcontrib>Lamfers, Evert JP</creatorcontrib><creatorcontrib>De Smet, Peter AGM</creatorcontrib><creatorcontrib>Kramers, Cornelis</creatorcontrib><title>Adherence to guidelines for the prescribing of double and triple combinations of antithrombotic agents</title><title>European journal of preventive cardiology</title><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><description>Background:To prevent cardiovascular complications, sometimes double and triple therapy with a vitamin K antagonist (VKA), clopidogrel and/or acetylsalicylic acid (ASA) are indicated. These combinations increase the patient’s risk of serious bleeding events. Therefore, adherence to clinical guidelines is of the utmost importance when these high-risk therapies are prescribed.
Methods:We performed a retrospective cohort study of 238 cases in a community pharmacy that were treated with a combination of VKA, clopidogrel and/or ASA between January 2006 and December 2009. Hospital records and community pharmacy records were used to obtain the indication(s), the duration of combination therapy, the presence of risk-increasing and risk-decreasing co-medications and any relevant co-morbidities. The cardiologists’ attitudes towards the prescribing of antithrombotic combinations and their self-reported adherence to guidelines were assessed by a brief questionnaire.
Results:We found there was no guideline-based indication for 22 of the 146 cases (14%) on ASA plus clopidogrel and 19 of the 82 cases (23%) on VKA plus ASA. Of the 238 cases given antithrombotic combination therapies, 77 (32%) were placed at an additional increased risk of serious gastrointestinal events, yet 43 (56%) of these did not receive adequate gastric protection. Out of the 19 of 60 cardiologists (32%) who responded to our questionnaire; 17 (90%) and 13 (68%) stated that a strict indication is very important when initiating therapy with ASA plus clopidogrel or ASA plus VKA, respectively.
Conclusions:There is room to further develop adherence to guideline-based prescribing of antithrombotic combination therapies and to improve prescription of gastric protection for patients receiving these high-risk combinations.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aspirin - therapeutic use</subject><subject>Attitude of Health Personnel</subject><subject>Biological and medical sciences</subject><subject>Bones, joints and connective tissue. Antiinflammatory agents</subject><subject>Cardiology. Vascular system</subject><subject>Clopidogrel</subject><subject>Community Pharmacy Services</subject><subject>Comorbidity</subject><subject>Drug Interactions</subject><subject>Drug Prescriptions</subject><subject>Drug Therapy, Combination</subject><subject>Drug Utilization Review - trends</subject><subject>Female</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Guideline Adherence - trends</subject><subject>Health Care Surveys</subject><subject>Health Knowledge, Attitudes, Practice</subject><subject>Heart</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - prevention & control</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Pharmacology. Drug treatments</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surveys and Questionnaires</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Ticlopidine - therapeutic use</subject><subject>Vitamin K - antagonists & inhibitors</subject><issn>2047-4873</issn><issn>2047-4881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEtLJDEQgMOirOLO3ZPksuClNa_upI8i6wMGPLj3Jp1UZjL0JGOSPuy_N8OMCgvWpYqqr6rgQ-iSkhtKpbxlREihJKdMtJS1_Ac637caoRQ9-awlP0OLnDekRkcYU-onOmOsU4K2_By5O7uGBMEALhGvZm9h8gEydjHhsga8S5BN8qMPKxwdtnEeJ8A6WFyS39XSxG0d6uJjyHtCh-LLOtVuLN5gvYJQ8i906vSUYXHMF-j14c_f-6dm-fL4fH-3bIwgfWmMlXLUQHTfwmgVMC2c5c5SCpRZwkgr296BNNDpruVCVNiNo1LWdYrxC3R9uLpL8W2GXIatzwamSQeIcx6o6LkitONdRckBNSnmnMANu-S3Ov0bKBn2eof_9daVq-P1edyC_Vz4kFmB30dAZ6Mnl3QwPn9xirWE9bJyzYHLVc6wiXMK1cn3j98BtE6Qsg</recordid><startdate>20140201</startdate><enddate>20140201</enddate><creator>Herwaarden, Margaretha F Warlé-Van</creator><creator>Roukens, Monique</creator><creator>Pop, Gheorghe AM</creator><creator>Lamfers, Evert JP</creator><creator>De Smet, Peter AGM</creator><creator>Kramers, Cornelis</creator><general>SAGE Publications</general><general>Sage Publications</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140201</creationdate><title>Adherence to guidelines for the prescribing of double and triple combinations of antithrombotic agents</title><author>Herwaarden, Margaretha F Warlé-Van ; Roukens, Monique ; Pop, Gheorghe AM ; Lamfers, Evert JP ; De Smet, Peter AGM ; Kramers, Cornelis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-cd77bae0a95ebd8e2a4fd3fd11e12d0205759fe7ce6a65344baefbb88df6823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aspirin - therapeutic use</topic><topic>Attitude of Health Personnel</topic><topic>Biological and medical sciences</topic><topic>Bones, joints and connective tissue. Antiinflammatory agents</topic><topic>Cardiology. Vascular system</topic><topic>Clopidogrel</topic><topic>Community Pharmacy Services</topic><topic>Comorbidity</topic><topic>Drug Interactions</topic><topic>Drug Prescriptions</topic><topic>Drug Therapy, Combination</topic><topic>Drug Utilization Review - trends</topic><topic>Female</topic><topic>Fibrinolytic Agents - adverse effects</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Guideline Adherence - trends</topic><topic>Health Care Surveys</topic><topic>Health Knowledge, Attitudes, Practice</topic><topic>Heart</topic><topic>Hemorrhage - chemically induced</topic><topic>Hemorrhage - prevention & control</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Pharmacology. Drug treatments</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surveys and Questionnaires</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Ticlopidine - therapeutic use</topic><topic>Vitamin K - antagonists & inhibitors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Herwaarden, Margaretha F Warlé-Van</creatorcontrib><creatorcontrib>Roukens, Monique</creatorcontrib><creatorcontrib>Pop, Gheorghe AM</creatorcontrib><creatorcontrib>Lamfers, Evert JP</creatorcontrib><creatorcontrib>De Smet, Peter AGM</creatorcontrib><creatorcontrib>Kramers, Cornelis</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of preventive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Herwaarden, Margaretha F Warlé-Van</au><au>Roukens, Monique</au><au>Pop, Gheorghe AM</au><au>Lamfers, Evert JP</au><au>De Smet, Peter AGM</au><au>Kramers, Cornelis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adherence to guidelines for the prescribing of double and triple combinations of antithrombotic agents</atitle><jtitle>European journal of preventive cardiology</jtitle><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><date>2014-02-01</date><risdate>2014</risdate><volume>21</volume><issue>2</issue><spage>231</spage><epage>243</epage><pages>231-243</pages><issn>2047-4873</issn><eissn>2047-4881</eissn><abstract>Background:To prevent cardiovascular complications, sometimes double and triple therapy with a vitamin K antagonist (VKA), clopidogrel and/or acetylsalicylic acid (ASA) are indicated. These combinations increase the patient’s risk of serious bleeding events. Therefore, adherence to clinical guidelines is of the utmost importance when these high-risk therapies are prescribed.
Methods:We performed a retrospective cohort study of 238 cases in a community pharmacy that were treated with a combination of VKA, clopidogrel and/or ASA between January 2006 and December 2009. Hospital records and community pharmacy records were used to obtain the indication(s), the duration of combination therapy, the presence of risk-increasing and risk-decreasing co-medications and any relevant co-morbidities. The cardiologists’ attitudes towards the prescribing of antithrombotic combinations and their self-reported adherence to guidelines were assessed by a brief questionnaire.
Results:We found there was no guideline-based indication for 22 of the 146 cases (14%) on ASA plus clopidogrel and 19 of the 82 cases (23%) on VKA plus ASA. Of the 238 cases given antithrombotic combination therapies, 77 (32%) were placed at an additional increased risk of serious gastrointestinal events, yet 43 (56%) of these did not receive adequate gastric protection. Out of the 19 of 60 cardiologists (32%) who responded to our questionnaire; 17 (90%) and 13 (68%) stated that a strict indication is very important when initiating therapy with ASA plus clopidogrel or ASA plus VKA, respectively.
Conclusions:There is room to further develop adherence to guideline-based prescribing of antithrombotic combination therapies and to improve prescription of gastric protection for patients receiving these high-risk combinations.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>22684153</pmid><doi>10.1177/2047487312451253</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; SAGE Complete A-Z List; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Aspirin - therapeutic use Attitude of Health Personnel Biological and medical sciences Bones, joints and connective tissue. Antiinflammatory agents Cardiology. Vascular system Clopidogrel Community Pharmacy Services Comorbidity Drug Interactions Drug Prescriptions Drug Therapy, Combination Drug Utilization Review - trends Female Fibrinolytic Agents - adverse effects Fibrinolytic Agents - therapeutic use Guideline Adherence - trends Health Care Surveys Health Knowledge, Attitudes, Practice Heart Hemorrhage - chemically induced Hemorrhage - prevention & control Humans Male Medical sciences Middle Aged Netherlands Pharmacology. Drug treatments Platelet Aggregation Inhibitors - therapeutic use Practice Guidelines as Topic Practice Patterns, Physicians' - trends Retrospective Studies Risk Assessment Risk Factors Surveys and Questionnaires Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use Vitamin K - antagonists & inhibitors |
| title | Adherence to guidelines for the prescribing of double and triple combinations of antithrombotic agents |
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