title: [Impact of pharmacotherapeutic warnings on the prescription of clopidogrel and proton pump inhibitors in hospitalised patients].
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Farmacia Hospitalaria, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España. msanchezruizdegordoa@yahoo.es
authors: M
authors: M
authors: Sánchez Ruiz-Gordoa
authors: J M
authors: JM
authors: Tenías Burillo
authors: R
authors: R
authors: Ruiz Martín de la Torre
authors: J C
authors: JC
authors: Valenzuela Gámez
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D000077144:Clopidogrel; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D006757:Hospital Units; D006761:Hospitals; D006801:Humans; D008137:Longitudinal Studies; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D013030:Spain; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine