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      Tendencia en la utilización de antiagregantes en la Comunidad Valenciana (2000-2005) Translated title: Trend in Platelet Antiaggregants Utilization in the Autonomous Community of Valencia, Spain (2000-2005)

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          Abstract

          Fundamento: Los antiagregantes plaquetarios son fármacos básicos para la prevención de enfermedades isquémicas arteriales. El objetivo de este trabajo es conocer la evolución de su utilización en Atención Primaria en la Comunidad Valenciana durante el periodo 2000-2005. Métodos: Estudio descriptivo del consumo de los antiagregantes plaquetarios (código ATC: B01AC) dispensados con cargo al Sistema Nacional de Salud en la Comunidad Valenciana en el ámbito de Atención Primaria. Datos expresados en dosis diarias definidas (DDD) por 1.000 habitantes y día. Resultados: En 2005 tres fármacos representaron el 98% de la prescripción global (ácido acetilsalicílico (AAS) 66%, clopidogrel 23% y triflusal 9%). El consumo de antiagregantes orales se incrementó en un 23% entre 2000 y 2005 (desde 29,6 DDD/1.000 hab y día hasta 36,5). El clopidogrel mostró un incremento del 218%, mientras que el ácido acetilsalicílico fue el principio de mayor consumo con una cuota de utilización bastante estable durante todo el periodo (próxima al 70%). El gasto generado por este grupo de fármacos se duplicó, el clopidogrel fue el fármaco con mayor coste/DDD (2,14 €), en 2005 su utilización constituyó un 23% del total de antiagregantes pero su gasto representó el 76% del total. Conclusiones: En este periodo se incrementó el consumo de antiagregantes en la Comunidad Valenciana. El AAS mantuvo estable su utilización, mientras que el clopidogrel aumentó su cuota de mercado pese a las recomendaciones de las guías terapéuticas y las restricciones para su uso. El consumo del clopidogrel contribuyó de forma notable al gasto farmacéutico de este grupo.

          Translated abstract

          Background: Platelet antiaggregants are basic drugs for preventing ischemic arterial diseases. This study is aimed at ascertaining the trend in their use in Primary Care in the Autonomous Community of Valencia during the 2000-2005 period. Methods: Descriptive study of the use of platelet antiaggregants (ATC code: B01AC) dispensed charged to the National Health System in the Autonomous Community of Valencia in Primary Care. Data given in defined daily doses (DDD) per 1,000 inhabitants per day. Results: In 2005, three drugs totalled 98% of all those prescribed overall (acetyl salicylicacid (ASA) 66%, clopidogrel 23% and triflusal 9%). Oral antiaggregant use rose by 23% within the 2000-2005 period (from 29.6 to 36.5 DDD/1,000 inhab./day). Clopidogrel showed a 218% increase, whilst ASA was the most used drug, with quite a stable percentage of use throughout said time period (nearing 70%). The expense generated by this group of drugs doubled, clopidogrel having been the highest-cost drug/DDD (2.14 EUROS), its use having totalled 23% of all antiaggregants yet the expense thereof having totalled 76% of the total expenditure. Conclusions: The use of antiaggregants increased in the Autonomous Community of Valencia during the time period under study. The utilization of ASA remained stable, whilst clopidogrel increased its market share despite the treatment guide recommendations and the restrictions on its use. The consumption of clopidogrel noticeably contributed to the drug spending for this group.

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          Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding.

          Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel. Copyright 2005 Massachusetts Medical Society.
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            Guidelines for ATC classification and DDD assignment

            (2001)
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              Upper gastrointestinal bleeding associated with antiplatelet drugs.

              The risk of major upper gastrointestinal bleeding associated with various antiplatelet drugs and the protection conferred by gastroprotective agents are not well defined. To estimate the risk of upper gastrointestinal bleeding associated with the use of antiplatelet drugs and its prevention by gastroprotective agents. In a case-control study, we compared all cases of upper gastrointestinal bleeding from a gastric or duodenal lesion in patients over 18 years of age (2813 cases), with 7193 matched controls. Odds ratios of upper gastrointestinal bleeding for individual antiplatelet drugs with adjustment for potential confounders were estimated. The individual risks of upper gastrointestinal bleeding were cardiovascular acetylsalicylic acid 4.0 (3.2-4.9), clopidogrel 2.3 (0.9-6.0), dipyridamole 0.9 (0.4-2.0), indobufen 3.8 (1.2-12.2), ticlopidine 3.1 (1.8-5.1) and triflusal 1.6 (0.9-2.7). Concomitant proton pump inhibitors decreased all risk estimates. For acetylsalicylic acid plus a proton pump inhibitor, the odds ratio was 1.1 (0.5-2.6). As a group, antiplatelet drugs accounted for 14.5% of all cases of upper gastrointestinal bleeding, i.e. 58 per million per year (334 per million per year among those older than 70 years). The risk of upper gastrointestinal bleeding is substantially decreased by the concomitant use of proton pump inhibitors. The risk of acetylsalicylic acid plus a proton pump inhibitor seems lower than that of ticlopidine or clopidogrel.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                June 2007
                : 81
                : 3
                : 279-287
                Affiliations
                [01] orgnameUniversitat de Valencia (UVEG) orgdiv1Departamento Farmacología España
                [03] orgnameGeneralitat Valenciana orgdiv1Consellería de Sanitat orgdiv2Dirección General de Salud Pública
                [02] orgnameGeneralitat Valenciana orgdiv1Consellería de Sanitat orgdiv2Agencia Valenciana de Salud España
                Article
                S1135-57272007000300005 S1135-5727(07)08100300005
                10.1590/s1135-57272007000300005
                129df20d-e099-4f32-87bf-63af39c0ac5b

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 9
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                SciELO Public Health

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                Utilización de medicamentos,Clopidogrel,Ácido acetilsalicícico,Aspirin,Antiagregantes plaquetarios,Drug utilizatión,Platelet aggregation inhibitors

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