Impacto de las alertas farmacoterapéuticas sobre la prescripción de clopidogrel e inhibidores de la bomba de protones en pacientes ingresados / Impact of pharmacotherapeutic warnings on the prescription of clopidogrel and proton pump inhibitors in hospitalised patients

Objetivo: Estimar el cambio en la frecuencia de la prescripción de clopidogrel combinado con inhibidores de la bomba de protones (IBP) en pacientes ingresados por enfermedad circulatoria, tras la aparición de alertas relacionadas con su asociación. Identificar la magnitud de la asociación de los factores que se relacionaron con la prescripción conjunta. Método Estudio observacional, analítico, longitudinal y retrospectivo en el que se evaluaron los cambios de prescripción de la asociación clopidogrel-IBP antes y después de la primera alerta oficial publicada. Se seleccionaron los pacientes que presentaron en el conjunto mínimo básico de datos (CMBD) algún código que incluyera enfermedad del sistema circulatorio, a los que se les prescribió durante su ingreso clopidogrel. Se registró el consumo concomitante de IBP (omeprazol y pantoprazol) en estos pacientes. Resultados Ingresaron 5.678 pacientes con diagnóstico de enfermedad circulatoria, de los que 13,6% llevaron clopidogrel durante el ingreso. En la fase prealerta la prescripción combinada fue significativamente mayor (80,8 vs 48,6). La prescripción conjunta disminuyó si el diagnóstico circulatorio fue el motivo principal de ingreso, si la enfermedad fue cardiaca, si el servicio médico de ingreso fue medicina interna/cardiología o medicina intensiva y cuantas más semanas transcurrieron tras la alerta. Conclusiones Ha disminuido la prescripción conjunta desde la primera alerta; sobre todo si el motivo de ingreso principal era circulatorio cardiaco y en el caso de omeprazol, que inhibe en mayor grado que pantoprazol el CYP2C19. Los servicios médicos más relacionados con las enfermedades circulatorias se adhieren más a las directrices de las alertas (AU)

Objective: to estimate the frequency of clopidogrel prescriptions in association with protonpump inhibitors (PPIs) in patients hospitalised with circulatory pathologies, after the publication of several warnings about this association. To identify and quantify the magnitude of the factors related to the prescription of both drugs. Methodology: observational, analytical, longitudinal, and retrospective study assessing changes in prescription of clopidogrel-PPIs association after and before the first official warning (about these drugs’ interactions) was published. We selected all patients with a code indicating a circulatory system disease in the Minimum Basic Data Set, who had been prescribed clopidogrel during hospital admission. We also evaluated proton pump inhibitor use in these patients (omeprazole and pantoprazole).Results: 5678 patients diagnosed with circulatory diseases were admitted during 2009, andclopidogrel was prescribed in 13.6% of them. In the pre-warning period, clopidogrel-PPIs prescriptions were significantly higher than in the post-warning period (80, 8% vs 48, 6%), especially in omeprazole. The combined prescription was lower if the circulatory diagnosis was the main cause for hospitalisation, if the patient had heart disease, if the patient was admitted in Internal Medicine/Cardiology or Intensive care units, and if the period of time was further fromwarning. Conclusion: combined prescription has decreased since the first warning, above all in patients with a primary circulatory heart disease. Omeprazole is a potent CYP2C19 inhibitor, so it was used in lower rates than pantoprazole in association with clopidogrel. Medical departments related to cardiovascular disease followed the warning more than others (AU)

[Impact of pharmacotherapeutic warnings on the prescription of clopidogrel and proton pump inhibitors in hospitalised patients]. / Impacto de las alertas farmacoterapéuticas sobre la prescripción de clopidogrel e inhibidores de la bomba de protones en pacientes ingresados.

OBJECTIVE: To estimate the frequency of clopidogrel prescriptions in association with proton pump inhibitors (PPIs) in patients hospitalised with circulatory pathologies, after the publication of several warnings about this association. To identify and quantify the magnitude of the factors related to the prescription of both drugs. METHODOLOGY: Observational, analytical, longitudinal, and retrospective study assessing changes in prescription of clopidogrel-PPIs association after and before the first official warning (about these drugs' interactions) was published. We selected all patients with a code indicating a circulatory system disease in the Minimum Basic Data Set, who had been prescribed clopidogrel during hospital admission. We also evaluated proton pump inhibitor use in these patients (omeprazole and pantoprazole). RESULTS: 5678 patients diagnosed with circulatory diseases were admitted during 2009, and clopidogrel was prescribed in 13.6% of them. In the pre-warning period, clopidogrel-PPIs prescriptions were significantly higher than in the post-warning period (80, 8% vs 48, 6%), especially in omeprazole. The combined prescription was lower if the circulatory diagnosis was the main cause for hospitalisation, if the patient had heart disease, if the patient was admitted in Internal Medicine/Cardiology or Intensive care units, and if the period of time was further from warning. CONCLUSION: Combined prescription has decreased since the first warning, above all in patients with a primary circulatory heart disease. Omeprazole is a potent CYP2C19 inhibitor, so it was used in lower rates than pantoprazole in association with clopidogrel. Medical departments related to cardiovascular disease followed the warning more than others.