plavix and MURs

[johnep]

Being prodded re MURs so thought about looking at Plavix pts. Note from BNF that combined with aspirin supposed to be two years, but how long for monotherapy with Plavix?
johnep

[kemzero]

2 years ?? current NICE guidelines stipulate up to 6 months if used concomitantly with aspirin 75mg for ACS ( Acute Coronary Syndrome) although most local guidelines / hospital consultants tend to go for 12 months.


As for plavix on its own ....surely in most cases it would be indefinitely because patients on this can't tolerate aspirin 75mg ...

research has also shown that most people over 65 , suffer from GIT bleeding when using both for a long time ....Clopidogrel does errode the stomach lining but not as mucg as asiprin .. so IMHO good MUR advice would be to take it with or after meals

[johnep]

So the targets for MURs would be pts on Clop + Asp for longer than one year?

Will PMR systems filter these pts out for me?
johnep

[kemzero]

depends on your computer system really
most GPs , patients and PCTs usually welcome such interventions ...particularly patients coz it could mean them taking one or two pills less e.g clopi and a PPI/H2 antagonist

[SolomonQ]

glucosamine has limited evidence for it's use so, one would suggest ceasing that. or even switching it to a non K form.

[Band6]

With clopridogrel, it is one of those items that you need to know what the patient is being treated for and under what circumstances. If the patient has had a stent fitted, but the cardiologist had trouble placing it and it is at a bit of an odd angle in the lumen, the patient may need to be on clopridogrel for a lot longer...

Peripheral vascular disease is another indication for life-long (or limb-long!) therapy if the patient cannot tolerate warfarin.

[Titch]

Speaking as a practice pharmacist I would love pharmacists to do MURs on people taking clopidogrel.

I acknowledge that some background info is needed as to why it is being taken but in general:

Combination of aspirin+clopidogrel only licensed for up to 1 year - normally stop clopidogrel after 1 year and continue with aspirin alone
Sometimes both needed long-term but pt should be counselled re increased GI risk

Clopidogrel alone - used where aspirin not tolerated but in reality this is a grey area and it's often started when someone has had GI symptoms with aspirin. A more logical route these days would be to add a PPI and the evidence that clopidogrel is less GI-irritant is poor: the main study comapres clopidogrel to 325mg aspirin daily - hardly a realistic dose.


Even just a MUR that confirms the symptoms someone gets when they take aspirin is useful and welcome to the GP as at least the prescribing of clopidogrel can be justified or reviewed via this information.

[johnep]

Presume Aspirin + ppi cheaper than clopidogel. Certainly prescribing of ppis with NSAIDs now frequent.
johnep