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.