Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov;83(11):2528-2540.
doi: 10.1111/bcp.13355. Epub 2017 Aug 1.

Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people

Ilaria Ardoino  1 , Raffaella Rossio  2 , Donnatella Di Blanca  3 , Alessandro Nobili  3 , Luca Pasina  3 , Pier Mannuccio Mannucci  4 , Flora Peyvandi  2 , Carlotta Franchi  3 ; REPOSI Investigators
Affiliations

Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people

Ilaria Ardoino et al. Br J Clin Pharmacol. 2017 Nov.

Abstract

Aims: Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile.

Methods: Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged ≥65 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles.

Results: Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5-45.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3-34.0%).

Conclusions: This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention.

Keywords: antiplatelet therapy; appropriateness; cardio- and cerebrovascular prevention; internal medicine and geriatric wards; older people.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of the study
See this image and copyright information in PMC

Comment in

References

    1. Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe 2015: epidemiological update. Eur Heart J 2015; 36: 2673–2674. - PubMed
    1. Antithrombotic Trialists' (ATT) Collaboration , Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta‐analysis of individual participant data from randomized trials. Lancet 2009; 373: 1849–1860. - PMC - PubMed
    1. Yazdanyar A, Newman AB. The burden of cardiovascular disease in the elderly: morbidity, mortality, and costs. Clin Geriatr Med 2009; 25: 563–577. - PMC - PubMed
    1. Franchi C, Marcucci M, Mannucci PM, Tettamanti M, Pasina L, Fortino I, et al. Changes in clinical outcomes for community‐dwelling older people exposed to incident chronic polypharmacy: a comparison between 2001 and 2009. Pharmacoepidemiol Drug Saf 2016; 25: 204–211. - PubMed
    1. Franchi C, Tettamanti M, Pasina L, Djignefa CD, Fortino I, Bortolotti A, et al. Changes in drug prescribing to Italian community‐dwelling elderly people: the EPIFARM‐Elderly Project 2000–2010. Eur J Clin Pharmacol 2014; 70: 437–443. - PubMed

MeSH terms