Description

Gallagher et al used the STOPP (Screening Tool of Older Person's Prescriptions) to help guide therapy in older adults. An important category are those used for patients with cardiovascular disorders. The authors are from Cork University in Ireland.


 

Patient selection: age >= 65 years

 

Cardiovascular Drugs

Comorbid

Other

Adverse Effect

digoxin, long-term

impaired renal function

 

risk digoxin toxicity

thiazide

gout

 

exacerbation gout

non-cardio selective beta blocker

COPD

 

risk of bronchospasm

beta-blocker

 

with verapamil

risk of heart block

verapamil or diltiazem

NYHA class III or IV heart failure

 

worsening of heart failure

calcium channel blocker

constipation

 

worsening of constipation

aspirin

warfarin

without histamine H2 receptor antagonist (but not cimetidine) or PPI

risk for GI bleeding

aspirin

past history peptic ulcer disease

without histamine H2 receptor antagonist or PPI

risk of GI bleeding

aspirin, high dose (> 150 mg/day)

 

 

risk of bleeding without evidence of efficacy

aspirin

bleeding disorder

 

bleeding

warfarin

bleeding disorder

 

bleeding

clopidogrel

bleeding disorder

 

bleeding

dipyridamole

bleeding disorder

 

bleeding

 

 

Drug

Reason

 

dipyridamole

cardiovascular disease secondary prevention

no evidence of efficacy

aspirin

prevent coronary or peripheral vascular disease without history of

no evidence of efficacy

aspirin

dizziness not due to cerebrovascular disease

not indicated

warfarin for more than 6 months

first uncomplicated DVT

no added benefit

warfarin for more than 12 months

first uncomplicated pulmonary embolism

no proven benefit

loop diuretic

dependent ankle edema without heart failure

not indicated, compression hosiery should be used

loop diuretic monotherapy

hypertension

better alternatives

 

where:

• Cimetidine may interact with warfarin.

• PPI = proton pump inhibitor

• DVT = deep vein thrombosis

 


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