CV Update Guidelines & Debates Royal Pharmaceutical Society, Great Britain Barnet 27/01/09

Transcription

1 CV Update Guidelines & Debates Royal Pharmaceutical Society, Great Britain Barnet 27/01/09 Dr Ameet Bakhai, FRCP Cardiologist, Clinical Trials, Health Economics Barnet & Chase Farm NHS Trust Royal Free NHS Trust, University of Hertfordshire Bushey Spire Conflict of Interest: Consultant to companies, Research Grants Work with NICE, AMORE Health, Health Smart UK

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5 Years Atherothrombosis Significantly Shortens Life Expectancy (Prognosis) at Healthy History of Angina History of MI History of CVA Peeters et al. Eur Heart J 2002; 23: Framingham Heart Study

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13 Oral Anti-Platelet Therapy Maintenance for Cardiovascular Risk / Disease v2.0 Draft Primary Produced by NCL CVD Prevention Task Group primary author Dr Ameet Bakhai- Review Date Jan NCL Cardiac and Stroke Network Secondary When anti-platelet therapy is initiated in secondary care a clear written indication, which includes duration, should be recorded and communicated to primary care. Where a duration is NOT specified it is assumed the drug is to be continued long term. For complex patients not covered by these simplified guidelines - please contact the supervising consultant or Dr A Bakhai to assist. Ensure duration of therapy is flagged on GP s clinical notes if NOT for long term. Recommend for clopidogrel patients issued a clopidogrel patient card. For aspirin - enteric aspirin does not appear to confer advantage #.. Asymptomatic, Age 50, 10 year CVD risk 20% Aspirin 75 mg daily after Baseline BP 150 / 90 Atrial fibrillation pts for antithrombotic but not for anticoagulants: warfarin Aspirin 75 mg daily after Baseline BP 150 / 90 Asymptomatic with Diabetes Mellitus (I or II) with any of: Age 40 / metabolic syndrome / 10 year DM / HbA1c 9% / Tchol 6mmol/l / on drugs for BP / organ damage / family history of premature coronary disease (M 55, F 65) Aspirin 75 mg daily after Baseline BP 150 / 90 ST elevation MI without stent Aspirin 75mg daily Clopidogrel 75mg daily 12 months* ST elevation MI with stent Aspirin 75mg daily Clopidogrel 75mg daily for 12 months* Non-ST elevation MI / Unstable angina with / without stent Aspirin 75mg daily Clopidogrel 75mg daily for 12 months* Drug Eluting Stent with / without MI Aspirin 75mg daily Clopidogrel 75mg daily for 12 months* Bare Metal Stent with / without MI / UA Aspirin 75mg daily Clopidogrel 75mg daily for 4 weeks* Chronic Stable Angina without recent event (>12 months) / Peripheral Arterial Disease Aspirin 75mg daily * In certain situations cardiologist may specify shorter or longer clopidogrel duration Ischaemic Stroke/TIA (no AF) Dipyridamole SR 200mg bd 2 years plus Aspirin 75mgs daily Or Aspirin 75mg daily (for patients intolerant to dipyridamole) Or Clopidogrel 75mgs daily for aspirin allergic patients Recurrent Strokes / TIAs (no AF) (whilst on aspirin and dipyridimole) No evidence base to provide guidance on changing to different anti-platelet agent References: NICE Vascular Disease guidance TA090 NICE NSTE -ACS guidance TA080 NICE Post MI guidance (Mar 07) Joint British Society Guidance 2 (2005). Clopidogrel 12 mths local consensus. ^Circulation #National Prescribing Centre MeReC Bulletin 2005;15 Patient on Aspirin with GI symptoms or previous ulcer with either age 60 or also using another anti-platelet / warfarin / corticosteroids/ NSAIDs / SSRIs should have PPI cover.^ Ensure medication is taken with food. Eradicate H Pylori as needed. Add Lansoprazole 30mg / Omeprazole 20mg daily (check outcome). Patient with a new gastrointestinal bleed Discontinue aspirin and clopidogrel. Liaise with cardiologist and gastroenterologist urgently Aspirin Allergy (bronchospasm or angio-oedema) or rash, associated with administration of aspirin Clopidogrel 75mg

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15 United Kingdom Clinical Pharmacy Association (cardiac group) Clopidogrel Patient Card

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