[Prescription of platelet antiaggregants in secondary prevention of ischemic heart disease].

OBJECTIVE

To find out how many patients older than 64 years of age seen in a primary health care (PHC) centre receive antiplatelet drugs for secondary prevention of coronary heart disease (CHD), as well as by whom they are prescribed, which drug is chosen, and what are its contraindications, unwanted effects and motives for ending therapy.

DESIGN

Description of all cases of CHD among patients older than 64, identified through the audit of clinical records.

SETTING

Urban health care centre with 23,702 inhabitants, with 2,742 over 64, 2,660 of whom have clinical records.

SUBJECTS: Patients over 64 with CHD, seen in the health centre within 1993.

MEASUREMENTS AND INTERVENTIONS: Age, sex, type of CHD, therapy with a platelet aggregation inhibitor, drug used, dose, prescriptor, adverse events, contraindications.

RESULTS

We identified 179 cases of CHD, a prevalence of 6.7%, of which 60.9% were male. 94 patients received an antiplatelet drug: aspirin (88.3%), dypiridamol and triflusal (5.3% each) and ticlopidine (1 case). 111 patients were adequately treated, including 84 given aspirin or ticlopidine, 12 patients in which therapy was ended due to adverse events, and 15 patients in which use of antiaggregant drugs was contraindicated. All prescriptions originating from general practitioners were for aspirin, while specialists prescribed other drugs in 11% of cases.

CONCLUSION

Two-thirds of patients with CHD were correctly treated. Aspirin is the antiaggregant drug most frequently used, particularly among PHC physicians. Even low doses of aspirin were associated with interruptions of therapy due to adverse events.