EVALUATION OF CLOPIDOGREL USE IN MEDICAL PATIENTS OF A by mfu12935

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									                  EVALUATION OF CLOPIDOGREL USE IN MEDICAL PATIENTS OF A GENERAL TEACHING
                                                 HOSPITAL
                            Lee WY Vivian 1, Lau CM Candy1, Lau SM Connie1, Mo LH Calvin 1 , Chan YK Thomas2
    1
        School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong;2 Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong




Introduction                                                                                       Result
                                                                                                    Demographic Characteristics
 Clopidogrel is a new antiplatelet drug indicated for various
 cardiological and neurological conditions.       The use of                                        No. of patients                                    96
 clopidogrel is more favorable in acute coronary syndromes                                          No. of incidence of clopidogrel prescribed        112
 according to the CURE and PCI-CURE studies. However, its
 use is limited due to the high cost. In the year 2000/01, the                                     Demographic Data: (n= 112)
 total drug expenditure on clopidogrel (including both inpatient                                   Age                      68±9.8
 and outpatient uses) had risen from HK $ 300,000 (US$                                             Sex                  M: 61    F: 51
 38,460) (1 US$=7.8 HK$) to HK$ 1 million (US $ 128,205)                                           Smoking history Smoker: 19 Ex-smoker: 30 Non-smoker: 63
 which was 0.5% of the total drug expenditure for 2002/03.                                         Drinking historyDrinker: 10 Ex-drinker: 7 Non-drinker: 95
 The current study was conducted at the Prince of Wales                                            Hospital duration (average) 6 days
 Hospital (PWH) which is a local public teaching hospital in                                       In-patient               106      (94.6%)
                                                                                                   Out-patient              6        (5.4%)
 Hong Kong.
                                                                                                   Speciality Neurology: 8 Cardiology: 102 Others: 2
Objectives
                                                                                                   Disease States:
The objectives of this study were (1) to examine the                                               Cerebral Vascular Accident 15       (13.4%)
prescribing pattern of the use of clopidogrel in medical                                           Hypertension                     75      (67.0%)
patients, (2) to determine the side effect profile of clopidogrel                                  Hyperlipidemia               48     (42.9%)
in Chinese patients and (3) to analyze the cost of use of                                          Diabetic Mellitus                51      (45.5%)
clopidogrel in medical patients.                                                                   Ischemic Heart Disease       70     (62.5%)
                                                                                                   Angina                       87     (77.7%)
Methodology                                                                                        Congestive Heart Failure     12     (10.7%)
                                                                                                   Myocardial Infarction            48      (43.0%)
                                                                                                   Intermittent Claudication    5      (4.5%)
It was a retrospective study performed in patients who were
                                                                                                   Atrial Fibrillation              3       (2.7%)
prescribed with clopidogrel from April, 2000 to November,                                          Gastrointestinal problem Peptic/Duodenal ulcer: 5 (4.5%)
2002. Only discharge prescriptions from the cardiology and                                         Gastritis :                  2      (1.8%)
neurology wards and prescriptions from Speciality Out -                                            GI bleed:                    4      (3.6%)
Patient Clinic were studied. Data collected included
demographic data, indications, dosage, treatment duration,                                         Concomitant Medication:
treatment plan, and side effects.                                                                  Aspirin 96 (85.7%)
                                                                                                   Antiplatelets/ Anticoagulants 3          (2.7%)
Analysis was divided into three parts: indications, adverse
effects and cost. The Primary outcome was to determine                                            Indications of Clopidogrel
the appropriateness of indications and dosing pattern of the                                     Specialty             No of      Prescribed according % in the total
clopidogrel uses in the medical wards. The secondary                                                                   incidences to PWH guideline     incidence

outcomes were side effects, deaths, re-admission associated                                      Cardiology (CC+/-PCI)        98                   98         87.5%
                                                                                                 Cardiology (other)             4                    0             0%
with clopidogrel use and the cost of clopidogrel.                                                Neurology                      8                    7           6.3%
                                                                                                 Others                         2                    0             0%
                                                                                                                             112                  105         93.8%
                                                                                                  Side effects of clopidogrel in Chinese patients
Indications of clopidogrel at PWH
                                                                                                       Side effects         No of patient Percentage
•It is indicated for recurrent ischemic cerebral                                                       Hematological events            0          0%
 vascular disease despite treatment with aspirin.                                                      Major bleeding                  0          0%
                                                                                                       Minor bleeding                  4        3.6%
                                                                                                       Skin rash                       4        3.6%
•It is indicated in post coronary intervention for
 duration of 4 weeks where unstable angina and                                                    Cost associated with clopidogrel usage in the audit
                                                                                                  1 US $ = 7.8 HK $
 gastrointestinal problems are not an absolute
 indication.                                                                                      Specialties                Total cost in the audit Cost per        % in total cost
                                                                                                                             (112 incidences)        treatment       in the audit
                                                                                                  Cardiology (CC+/-PCI)               HK$30,221.10        HK$308.38            47.6%

Conclusion
                                                                                                  Cardiology (other)                   HK$2,324.70         HK$581.18            3.7%
                                                                                                  Neurology                           HK$29,581.50       HK$3,697.69           46.5%
                                                                                                  Other                                HK$1,426.80         HK$713.40            2.2%
In this drug use evaluation, use of clopidogrel at PWH was in                                                                         HK$63,554.10         HK$567.45         100.0%
general appropriate. Clopidogrel was well tolerated. Skin rash
and minor bleeding were the most common side effects                                            CC= Cardiac catheterization
observed.                                                                                       PCI = Percutaneous coronary intervention

								
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