Status of the clopidogrel use in ACS patients and related factors among county hospitals in China
10.3760/cma.j.issn.0253-3758.2019.12.008
- VernacularTitle: 中国县级医院急性冠状动脉综合征患者氯吡格雷院内使用现况及相关因素
- Author:
Lin FENG
1
;
Yangfeng WU
2
;
Min LI
3
;
Wuxiang XIE
2
;
Xian LI
4
;
Aihua ZHANG
4
;
Runlin GAO
5
Author Information
1. Peking University First Hospital, Beijing 100034, China
2. Peking University Clinical Research Institute, Beijing 100191, China
3. Clinical Epidemiology and EBM Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
4. The George Institute for Global Health, Peking University Health Science Center, Beijing 100088, China
5. Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China
- Publication Type:Clinical Trail
- Keywords:
Acute coronary syndrome;
Clopidogrel;
Loading dose;
Associated factors
- From:
Chinese Journal of Cardiology
2019;47(12):985-992
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To observe the use of clopidogrel and related factors for patients with acute coronary syndrome (ACS) in terms of early use, loading dose, dual antiplatelet therapy (DAPT) and maintenance dose hospitalized in non-PCI country hospitals in China.
Methods:Patients hospitalized for ACS from 101 non-PCI country hospitals across China were recruited prospectively from October 2011 to November 2014. In-hospital clopidogrel use rate, the proportions of early use (within 24 hours), loading dose use (≥300 mg), DAPT (early use combined with aspirin) and maintenance dose use (following dose≥75 mg/d) were analyzed. Generalized estimated equation (GEE) model was used to explore factors associated to in-hospital clopidogrel use and loading dose use in both univariate and multivariate analyses, adjusting for cluster effect.
Results:A total of 14 809 ACS patients were included, with an average age of (64.1±11.6) years and 60% (8 888/14 809) were male. The in-hospital clopidogrel use rate was 66.4% (9 828/14 809), which varied across different regions, years and sub-types of ACS (all P<0.05). Among users, the proportions of patients with early use, DAPT and maintenance dose use were 91.3% (8 734/9 562), 89.2% (8 526/9 562) and 95.1% (9 094/9 562), respectively, but the proportion of patients received loading dose was only 41.8% (3 995/9 562). Multivariate analyses showed that patients who admitted to hospital in earlier years and with non-ST elevation ACS, ≥75 years old, female, non-smoking, illiterate, heart rate≥100 beats per minute, atrial fibrillation, not on ECG monitoring, and not using other anti-ACS drugs were less likely to receive clopidogrel (all P<0.05). And those clopidogrel users who with non-ST elevation ACS, ≥75 years old, non-smoking, illiterate, not using other anti-ACS drugs were less likely to receive loading dose (all P<0.05).
Conclusion:The use rate of clopidogrel and the loading dose among in-hospital ACS patients are both low and remain to be improved in non-PCI county hospitals in China. Special attention should be paid on non-ST elevation ACS, ≥75 years old, female, and illiterate patients to increase the rational use of clopidogrel and the loading dose.
