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More than half of antiplatelet therapies prescribed inappropriately

Antiplatelet therapy is often improperly dispensed to acutely hospitalized elderly patients, according to research recently published in the British Journal of Pharmacology.

“There is little evidence favoring [antiplatelet] use in the frame of primary prevention, because several studies have shown less benefits than risks,” Ilaria Ardoino, PhD, of the department of clinical sciences and community health at the University of Milan, and colleagues wrote. “Thus, a careful risk/benefit appraisal is warranted for the optimal prescription of antiplatelet drugs in older people.”

Researchers used data from a patient register held in several internal medicine and geriatric hospital wards in Italy and Spain in 2012 and 2014, focusing their analysis on 2,199 patients aged 65 or older. The appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles based on the

Ardoino and colleagues found that 43.6% of patients (95% CI, 41.5-45.7) were prescribed antiplatelet therapy, most frequently aspirin. Among patients who received primary prevention prescriptions, more than half (52.1%) were inappropriately prescribed. In this subset of 209 patients, overprescription was the error in most of the patients (n = 155). Researchers also noted a “high” rate of improper underprescription (30.6%) in the context of secondary prevention among 726 patients.

“This study showed a high degree of inappropriateness among hospitalized older patients prescribed with antiplatelets for primary prevention and a widespread underprescription for secondary prevention. Ticlopidine still remains largely prescribed in Italy, despite its documented risk of serious adverse events,” Ardoino and colleagues wrote. “Pharmacoepidemiological studies like this should be useful to stir clinicians to update their pharmacological knowledge and to highlight the need to review their therapies, in order to save resources and decrease the risk of adverse drug reactions in older patients.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.