PMID- 22441058
OWN - NLM
STAT- MEDLINE
DCOM- 20130308
LR  - 20181201
IS  - 2042-8189 (Electronic)
IS  - 1478-2715 (Linking)
VI  - 42
IP  - 1
DP  - 2012 Mar
TI  - Reducing co-administration of clopidogrel and proton pump inhibitors in acute 
      coronary syndromes.
PG  - 21-3
LID - 10.4997/JRCPE.2012.105 [doi]
AB  - BACKGROUND: Recent concerns about clopidogrel and proton pump inhibitor (PPI) 
      co-administration in patients following an acute coronary syndrome (ACS) led us 
      to investigate our practice. Guidance recommends that omeprazole and esomeprazole 
      should not be co-administered with clopidogrel as they can decrease its efficacy. 
      Pantoprazole and lansoprazole are safer for use in these cases. METHODS: Patients 
      discharged between August 2008 and July 2009 with a diagnosis of ACS, on both 
      clopidogrel and any PPI, were identified using the pharmacy database. Their notes 
      were retrospectively reviewed, the indication for a PPI was checked and whether 
      an appropriate one had been prescribed was assessed. As a result of our findings 
      a simple algorithm was introduced to set out guidance on appropriate use and 
      junior doctors were informed of the new procedure. We then performed another 
      audit of patients discharged between August 2009 and February 2010 to ensure that 
      the guidelines were being followed. RESULTS: During the first phase of the audit 
      43 out of 91 patients (47.5%) received a PPI with clopidogrel. Following our 
      intervention, re-auditing confirmed that clopidogrel and PPI co-administration 
      had decreased significantly to 27 out of 101 patients (26.7%) (p = 0.018). 
      CONCLUSIONS: Through a simple intervention with an algorithm and education of 
      junior doctors we have shown that significant improvement and adherence to 
      guidance can be achieved.
FAU - Vassiliou, V
AU  - Vassiliou V
AD  - Papworth Hospital, Cambridge CB1 8HD, UK. vassiliou@doctors.org.uk
FAU - Silva, A
AU  - Silva A
FAU - Kavvoura, F
AU  - Kavvoura F
FAU - Schofield, R
AU  - Schofield R
FAU - Rowlands, D B
AU  - Rowlands DB
LA  - eng
PT  - Journal Article
PL  - England
TA  - J R Coll Physicians Edinb
JT  - The journal of the Royal College of Physicians of Edinburgh
JID - 101144324
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Algorithms
MH  - Clopidogrel
MH  - *Drug Interactions
MH  - Drug Therapy, Combination
MH  - *Guideline Adherence
MH  - Humans
MH  - Medical Audit
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Practice Guidelines as Topic
MH  - Prescriptions/*standards
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Retrospective Studies
MH  - Ticlopidine/*analogs & derivatives/therapeutic use
EDAT- 2012/03/24 06:00
MHDA- 2013/03/09 06:00
CRDT- 2012/03/24 06:00
PHST- 2012/03/24 06:00 [entrez]
PHST- 2012/03/24 06:00 [pubmed]
PHST- 2013/03/09 06:00 [medline]
AID - 10.4997/JRCPE.2012.105 [doi]
PST - ppublish
SO  - J R Coll Physicians Edinb. 2012 Mar;42(1):21-3. doi: 10.4997/JRCPE.2012.105.