Appropriate use of antiplatelets: is prescription in daily practice influenced by the global cardiovascular risk?
OBJECTIVE
To evaluate the appropriate prescription of antiplatelets according to patients' global cardiovascular risk level in everyday practice.


METHODS
In a cross-sectional study, general practitioners (GPs) identified a random sample of 10% of patients at cardiovascular risk among all subjects coming to the surgery and collected data on cardiovascular risk factors and history of atherosclerotic cardiovascular diseases (CVD). GPs were asked to do a physical examination and record the results of laboratory tests to define the global cardiovascular risk. The use of antiplatelet drugs in patients with established CVD and in healthy subjects at high risk of developing symptomatic atherosclerotic disease was evaluated.


RESULTS
A total of 162 GPs from all over Italy recruited 3,120 subjects (51% female, mean age 64 years). Of the 949 with an indication for antiplatelet treatment for secondary prevention of CVD, 442 (47%) were receiving it. Among the 2,071 without CVD, 11% were taking an antiplatelet drug. In this group, antiplatelets were prescribed in 6, 10, 16 and 23%, respectively, of patients perceived by GPs to be at mild, moderate, high and very high cardiovascular risk.


CONCLUSIONS
Prescription of antiplatelets still seems to be far from what is recommended in virtually all patients with a history of CVD. In subjects with cardiovascular risk factors but without CVD antiplatelet prescription increases in relation to global cardiovascular risk but is still low in patients at high or very high risk of cardiovascular events.
Monesi
Lara
L
Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea 62, 20157, Milano, Italy.
Avanzini
Fausto
F
Barlera
Simona
S
Caimi
Vittorio
V
Lauri
Davide
D
Longoni
Paolo
P
Roccatagliata
Daria
D
Tombesi
Massimo
M
Tognoni
Gianni
G
Roncaglioni
Maria Carla
MC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention; D018570:Risk Assessment; D013988:Ticlopidine / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine; D001241:Aspirin