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| |  Many Dialysis Patients Undergoing PCI Receive Improper Medication, With Increased Risk of Bleeding CHICAGO -- December 8, 2009 -- Approximately 20% of patients on dialysis undergoing a percutaneous coronary intervention (PCI) are given an antithrombotic medication they should not receive, which may increase their risk for in-hospital bleeding, according to a study published in the December 9 issue of JAMA. “In the United States, medication errors are implicated in more than 100,000 deaths annually,” the authors wrote. “Medication errors include adverse drug reactions related to inappropriately prescribed or administered drugs. To minimise inappropriate medication use, the US Food and Drug Administration (FDA) guides pharmaceutical manufacturers and clinicians through drug labelling of which medications are contraindicated or not recommended for use in specific patient groups. Little is known about the use of such medications and their effects on outcomes in clinical practice.” Thomas T. Tsai, MD, Denver VA Medical Center and University of Colorado Denver, Denver, Colorado, and colleagues examined the use of the contraindicated/not-recommended antithrombotic agents enoxaparin and eptifibatide among dialysis patients undergoing PCI and their association with outcomes. The researchers used data from the National Cardiovascular Data Registry (NCDR) from 829 US-based hospitals on 22,778 dialysis patients who underwent PCI between January 2004 and August 2008. The study focused on the outcomes of in-hospital bleeding and death. Overall, 5,084 patients (22.3%) received a contraindicated antithrombotic medication; 2,375 (46.7%) received enoxaparin, 3,261 (64.1%) received eptifibatide, and 552 (10.9%) received both. In unadjusted analysis, patients who received contraindicated antithrombotics experienced higher rates of in-hospital major bleeding (5.6% vs 2.9%) and death (6.5% vs 3.9%). Further analysis indicated that receipt of contraindicated antithrombotics was significantly associated with increased in-hospital major bleeding, but no significant association was found with in-hospital death. “This study therefore demonstrates that these medications are used in clinical practice despite FDA-directed labelling, and their use is associated with adverse patient outcomes,” the authors wrote. “Educational efforts targeting clinicians who prescribe these medications and quality improvement interventions, such as amending clinical pathway order sets to include consideration of renal function, are urgently needed.”
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