Use of Antiplatelets for Primary and Secondary Prevention of Cardiovascular Events in the Medical Outpatient Setting of a Tertiary Centre in Nigeria: A Six-Month Review

Abstract

Abstract Background: Cardiovascular disease (CVD) is the leading cause of death globally. The use of antiplatelets in the secondary prevention of CVD is well established. Their role in primary prevention of CVD is uncertain. Aim: The aim of the study was to determine the prevalence and pattern of antiplatelet prescription as well as the clinical determinants for their use at a medical outpatient setting in a tertiary hospital in Nigeria. Materials and Methods: The study was a retrospective, cross-sectional study of antiplatelet prescription at the medical outpatient clinic of a Nigerian tertiary hospital over a six-month period. Medical records of 200 adults were selected by the simple random sampling after excluding atrial fibrillation, acute pericarditis, chronic stable angina, acute rheumatic fever, and preeclampsia. Results: We studied the records of 200 patients. Antiplatelets were prescribed for the majority of participants (65.5%), out of which 85.5% were for the primary prevention of CVD. Of those receiving antiplatelets for secondary prevention, about eight out of every ten had a prior stroke and/or transient ischemic attack. There was a significant difference in the use of antiplatelets across age groups (χ 2 = 45.275 and P < 0.001). Subjects <50 years of age were significantly less likely to use antiplatelet than those 50 years and above ( P < 0.001, odds ratio = 0.112, and 95% confidence interval = 0.052–0.245). The odds of hypertensive and diabetic patients receiving antiplatelets were about 12 and 3 times those of patients without hypertension and diabetes, respectively. The use of antiplatelets did not show any significant relationship with sex, duration of hypertension, duration of diabetes, smoking status, congestive heart failure, and chest pain. Of the patients on antiplatelets, 44% were receiving drugs that cause additional bleeding risk. Three percent of patients reported side effects. Conclusion: Our study has found a high degree of antiplatelet utilisation for the primary prevention of CVD in spite of the current lack of evidence in recent trials. We encourage formal CVD risk assessment for all patients in whom antiplatelets are considered for primary CVD prevention.