Current perspectives on British use of adjunctive therapies during coronary interventions

Background: Interventional techniques are commonly performed with adjunctive therapy including clopidogrel, ticlopidine, abciximab and heparin. We wished to assess the current British use of antiplatelet and anticoagulant agents as adjunctive therapies in interventional cardiology in the light of the available evidence base regarding their usage. Methods: A simple structured questionnaire was sent between August and October 1999 to all interventional cardiology consultants working in the UK regarding their usage of abciximab (ReoPro), heparin, clopidogrel (Plavix) and ticlopidine (Ticlid) peri-procedurally. Results: 68% of consultants responded over the next 4 months, with many replying jointly for a centre rather than individually. Average abciximab use was 8.3% of interventional cases. Eighty-two percent of clinicians used clopidogrel in stented patients. Exact dosages varied considerably. Fifty-three percent of clinicians gave 10 000 IU or more of heparin routinely. Conclusions: These figures are not in line with the published evidence and British interventionists appear to have adopted various strategies to target the use of these agents. In particular, abciximab appears to be being administered reactively, as and when problems arise in the catheterisation lab.