1 / 8

Ted Williams Pharm D Candidate Monday Lab – Group D

A Review of – Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events. Ted Williams Pharm D Candidate Monday Lab – Group D. Clopidogrel & Aspirin - When should pharmacist intervene?. Joe, 47 yo male Diabetic Betty, 68 yo female with a hx of Angina

vondra
Download Presentation

Ted Williams Pharm D Candidate Monday Lab – Group D

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Review of –Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events Ted Williams Pharm D Candidate Monday Lab – Group D

  2. Clopidogrel & Aspirin - When should pharmacist intervene? • Joe, 47 yo male Diabetic • Betty, 68 yo female with a hx of Angina • Phil, 76 yo male 2 yrs post-PCI • Jean, 57 yo female hospital discharge orders for Clopidogrel, ASA, Metoprolol Succinate, Lisinopril, Lipitor, Nitroglycerin SL, oxycodone, Hydrocodone/APAP

  3. Study Objective • Determine if Clopidogrel + ASA 81mg decreases risk of CV Events vs. ASA 81mg alone.

  4. Methods – for completeness • Study Design • Multicenter, randomized, double-blind, placebo-controlled (n=15,603) • Executed by Cleveland Clinic Cardiovascular Coordination Center • Sponsored by Sanofi-Aventis & Bristol-Myers (Plavix Patent holder) • Plavix + ASA 81mg vs. Placebo + ASA 81mg • Inclusions • >45yrs • Established CVD • Multiple risk factors for CVD • Efficacy • Primary end point of MI, Stroke, or Death due to CV event/hemorrhage • Secondary endpoint incidence of CV events or hospitalization for CAD related events • Safety • Pearson chi-square test

  5. Efficacy Findings Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events. (NEJM 2007;354:1706-17)

  6. Safety Findings • Moderate Bleeding significantly increased • GUSTO Moderate: bleeding that led to transfusion, but did not meet “severe” criteria Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events. (NEJM 2007;354:1706-17)

  7. Clopidogrel & Aspirin –When should pharmacists intervene? • Joe, 47 yo male diabetic • Diabetics should be on ASA 81mg (ADA) • Any Clopidogrel prescription should raise a question • Betty, 68 yo female with a hx of Angina • Dual therapy not indicated • Investigate with patient & MD • Phil, 76 yo male 2 yrs post-PCI • Dual therapy only recommended for 1 year (AHA/ACC) • Investigate • Jean, 57 yo female hospital discharge orders for Clopidogrel, ASA, MetoprololSuccinate, Lisinopril, Lipitor, Nitroglycerin SL, oxycodone, Hydrocodone/APAP • Sounds post-PCI to me… • No intervention, dual therapy indicated (AHA/ACC)

  8. References • Bhatt, B., Fox, D., Hacke, W., et al, (2007) Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events. NEJM 2007;354:1706-17. Retrieved from http://content.nejm.org/cgi/content/full/354/16/1706 on 01/21/2007 • The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82. Retrieved from http://content.nejm.org/cgi/content/full/329/10/673 • Smith, S., Allen, J., Blair, S., AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update . Retrieved from http://circ.ahajournals.org/cgi/content/full/113/19/2363 • Standards of Medical Care in Diabetes—2007 AMERICAN DIABETES ASSOCIATION Retrieved from http://care.diabetesjournals.org/cgi/reprint/30/suppl_1/S4

More Related