Monesi Lara, Avanzini Fausto, Barlera Simona, Caimi Vittorio, Lauri Davide, Longoni Paolo, Roccatagliata Daria, Tombesi Massimo, Tognoni Gianni, Roncaglioni Maria Carla
Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea 62, 20157, Milano, Italy.
Eur J Clin Pharmacol. 2005 Sep;61(8):595-601. doi: 10.1007/s00228-005-0948-z. Epub 2005 Jul 15.
To evaluate the appropriate prescription of antiplatelets according to patients' global cardiovascular risk level in everyday practice.
In a cross-sectional study, general practitioners (GPs) identified a random sample of 10% of patients at cardiovascular risk among all subjects coming to the surgery and collected data on cardiovascular risk factors and history of atherosclerotic cardiovascular diseases (CVD). GPs were asked to do a physical examination and record the results of laboratory tests to define the global cardiovascular risk. The use of antiplatelet drugs in patients with established CVD and in healthy subjects at high risk of developing symptomatic atherosclerotic disease was evaluated.
A total of 162 GPs from all over Italy recruited 3,120 subjects (51% female, mean age 64 years). Of the 949 with an indication for antiplatelet treatment for secondary prevention of CVD, 442 (47%) were receiving it. Among the 2,071 without CVD, 11% were taking an antiplatelet drug. In this group, antiplatelets were prescribed in 6, 10, 16 and 23%, respectively, of patients perceived by GPs to be at mild, moderate, high and very high cardiovascular risk.
Prescription of antiplatelets still seems to be far from what is recommended in virtually all patients with a history of CVD. In subjects with cardiovascular risk factors but without CVD antiplatelet prescription increases in relation to global cardiovascular risk but is still low in patients at high or very high risk of cardiovascular events.
在日常医疗实践中，根据患者的整体心血管风险水平评估抗血小板药物的合理处方。
在一项横断面研究中，全科医生（GPs）从前来就诊的所有受试者中随机抽取10%有心血管风险的患者样本，收集心血管危险因素和动脉粥样硬化性心血管疾病（CVD）病史的数据。要求全科医生进行体格检查并记录实验室检查结果，以确定整体心血管风险。评估已确诊CVD患者和有发生症状性动脉粥样硬化疾病高风险的健康受试者中抗血小板药物的使用情况。
来自意大利各地的162名全科医生招募了3120名受试者（51%为女性，平均年龄64岁）。在949名有抗血小板治疗二级预防指征的CVD患者中，442名（47%）正在接受治疗。在2071名无CVD的患者中，11%正在服用抗血小板药物。在这组患者中，全科医生认为心血管风险为轻度、中度、高度和极高的患者中，分别有6%、10%、16%和23%的患者使用了抗血小板药物。
抗血小板药物的处方似乎仍远低于几乎所有有CVD病史患者的推荐水平。在有心血管危险因素但无CVD的受试者中，抗血小板药物的处方量随整体心血管风险增加，但在心血管事件高风险或极高风险患者中仍然较低。
