title: Appropriateness of clopidogrel use according to current recommendations.
abstract: BACKGROUND
  Clopidogrel is widely used in cardiovascular prevention. However, the prescription of clopidogrel in clinical practice does not match the recommendations concerning its indication and treatment duration.
  
  
  OBJECTIVE
  To assess the appropriateness of clopidogrel prescription according to the accepted indications.
  
  
  METHODS
  We undertook a retrospective observational analytical audit of the electronic clinical records in the region of Valencia, Spain (5 million inhabitants), selecting those patients on treatment with clopidogrel between 2007 and 2010. The primary outcome measure was the duration of the treatment.
  
  
  RESULTS
  A total of 45721 patients started clopidogrel treatment during the study period. Treatment was for cardiologic disorders (CD) in 56.85% of the patients, neurologic disorders (ND) in 37.06% and peripheral arterial disease in 6.08%. Treatment duration was longer than that expected from clinical recommendations in 38.8% of the CD patients and 87.8% of the ND patients. The estimated avoidable cost ranged from 2 to 4.4 million Euros per year, according to whether a cheaper generic clopidogrel or a more expensive version was considered.
  
  
  CONCLUSIONS
  Almost 40% of the cardiologic patients and 90% of the neurologic patients received excess treatment. Adjustment of treatment duration to international recommendations would result in savings of between 80.1 and 176.3 Euros per year and per patient treated.
authors.affiliation: Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fornós-Garrigós
authors.affiliation: Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and Department of Family Medicine, Miguel Hernandez University, Ctra. Nnal. 332, Alicante-Valencia, s/n, San Juan de Alicante, Alicante 03550, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Orozco-Beltrán
authors.affiliation: Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and Department of Family Medicine, Miguel Hernandez University, Ctra. Nnal. 332, Alicante-Valencia, s/n, San Juan de Alicante, Alicante 03550, Spain. atencion.primaria@umh.es adriannalp@hotmail.com.
authors.forename: Vicente F
authors.initials: VF
authors.lastname: Gil-Guillén
authors.affiliation: Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and Department of Family Medicine, Miguel Hernandez University, Ctra. Nnal. 332, Alicante-Valencia, s/n, San Juan de Alicante, Alicante 03550, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Puig-Barberà
authors.affiliation: Valencia Society of Family and Community Medicine, c/Santa Cruz de la Zarza 4 bajo, 46021 Valencia and.
authors.forename: Carlos
authors.initials: C
authors.lastname: Fluixa
authors.affiliation: Department of Family Medicine, Miguel Hernandez University, Ctra. Nnal. 332, Alicante-Valencia, s/n, San Juan de Alicante, Alicante 03550, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D054869:Clinical Audit / Q000379:methods / Q000706:statistics & numerical data; D000077144:Clopidogrel; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000592:standards / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D063487:Prescription Drug Misuse / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000592:standards / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Cardiovascular agents; cardiovascular diseases; clopidogrel; health care costs; prescriptions; primary health care.