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The antiplatelet clopidogrel and the proton pump inhibitor esomeprazole demonstrate a pharmacokinetic interaction through CYP2C19 that could translate into clinical inefficacy of clopidogrel. No medical consensus as to their coprescription has been reached, and different guidelines are available. We evaluated the prescribing practices at the Geneva University Hospitals (HUG) by measuring whether the coprescription was staggered as suggested by experts. We estimated the financial impact of different implementation guidelines. We used the HUG electronic patient records to follow the physicians' prescriptions and the administration by nurses from January 2013 to April 2014. We performed a time series analysis to assess 15 years of proton pump inhibitors (PPIs) and antiplatelet drug use. “Extra costs” were calculated assuming that clopidogrel or esomeprazole would replace prasugrel or ticagrelor and pantoprazole or ranitidine, respectively. Only 10.8% of the patient medical orders for the clopidogrel and esomeprazole coprescription specified to stagger the administration, 12.6% specified a concomitant coprescription, and 76.6% had no clear information. A high rate of 49.6% of the nurses staggered the clopidogrel and esomeprazole coprescription when no clear information was given. We found a statistically significant decrease in clopidogrel use after the publication of the OCLA (Omeprazole–CLopidogrel–Aspirin) study and a significant increase in the trend of esomeprazole. Alternative treatments to avoid this interaction are cost ineffective or offer therapeutic options of lesser quality. We observed a high rate of 56.2% of the clopidogrel and esomeprazole coprescription in our hospital and can therefore not ignore the PK/PD interaction. The most common prescription practice was to not specify the time frame of administration, which was translated by nurses in 49.6% of the cases to a scheduled staggered coprescription of clopidogrel and esomeprazole. As long as no consensus has been reached, the medical orders time frame information should be mandatory to allow a clear and harmonious staggering strategy.

N= 4,350) were followed for one year using hospital Discharge Abstract Database. The severity of the stroke was obtained from the ambulatory care database. Median hospital costs by CMG+ group were obtained from Alberta Health. Hospitals were classified as teaching, community large, community medium, and community small hospitals. Hospitals were also classified as comprehensive stroke centre, urban and rural primary stroke centres, and other urban and rural hospitals. The adjusted risk factors in Bayesian Model included sex, age, all disease-specific co-morbidities, and disease severity. The results for four hospital types and five stroke center categories were calculated using the observed/expected approach. Results: The 30 days mortality rates (95% CI) were lowest for teaching hospitals 10.1% (9.0%-11.2%) and large community hospitals (10.0%; 8.3%-11.8%), and the small community hospitals had the highest mortality rates (12.8%; 9.9%-15.8%). The mean LOS (95% CI) varied from 21.7 (20.9-22.6) days in teaching hospitals to 34.2 (28.6-41.0) days in community medium hospitals. The community medium hospitals had significantly higher costs ($62,400; $49,900-$78,000) than the community large hospitals ($32,900; $29,900-$36,200) and teaching hospitals ($37,000; $34,900-$39,200). Both comprehensive stroke and urban stroke centers had lower 30 day mortality rates (95% CI): 9.9% (8.8%-11.1%) and 9.7% (7.3%-12.0%); shorter LOS 21.6 (20.7-22.5) and 25.0 (22.7-27.6) days; and medium levels of costs $39,300 ($36,100-$40,700), compared to other hospitals. ConClusions: The study shows the hospital type and stroke centre had limited effects on the mortality but significant impact on LOS and costs.objeCtives: This study examines the association of 30 day in-hospital mortality, length of stay (LOS) during the first hospital episode, and hospitalization costs during one year after acute ischemic stroke by type of hospital and by stroke centre