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Clopidogrel patients at serious adverse event risk

By Nigel Praities

Patients on clopidogrel are being placed at risk of serious adverse event because of major communication problems between secondary and primary care over the drug's use, a new audit concludes.

NICE recommends patients do not receive clopidogrel and aspirin for more than a year, but a study of 60 practices in Dudley found incomplete hospital information made it almost impossible for GPs to adhere to guidance properly.

Many patients were left on clopidogrel for long periods and left at risk of serious drug interactions and bleeding episodes.

This follows data from practices in Scotland published earlier this month that showed a third of patients in general practice were prescribed aspirin and clopidogrel for longer than the recommended year, because of uncertainties over guidelines.

The Dudley audit found documentation around clopidogrel prescribing was ‘very poor', with the intended length of clopidogrel treatment recorded in less than 5% of cases.

Of the 70% of combined aspirin and clopidogrel initiated in secondary care, many were for unlicensed indications. Clopidogrel was also widely co-prescribed with drugs with the potential for interactions, such as warfarin.

Anne Noott, primary investigator for the audit and a prescribing advisor at Dudley PCT, blamed some of the confusion on a lack of communication between specialists and GPs.

‘We all know admission and discharge notes are notoriously poor and some of the details get lost during the process. It often wasn't clear from the secondary discharge letter how long it should be prescribed for or there was no clear record in the GP practice notes,' she said.

With this lack of information, she said GPs often ‘played it safe' and kept patients on clopidogrel for longer or indefinitely, despite the risk of bleeding episodes.

Dr Stewart Findlay, a GP in Bishop Auckland, County Durham, and treasurer of the Primary Care Cardiovascular Society said this study showed GPs often had very little information about a patient after they are discharged from hospital.

‘This is a good example of poor communication resulting in patients getting appropriate treatment and resulting in dangers to patients. I'm afraid this is a constant problem,' he said.

Data from the audit appeared in the abstracts of the Royal Society of Medicine Drug Utilisation Research Group, published in the latest edition of Pharmacoepidemiology and Drug Safety.

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