Incidence of Bleeding in Renally Impaired Patients Receiving Incorrectly Dosed Eptifibatide or Bivalirudin While Undergoing Percutaneous Coronary Intervention

Taylor, Lindsey A; Mauro, Vincent F.

doi:10.1345/aph.1q402

Cited by 6 publications

(2 citation statements)

References 22 publications

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“…260,261 It inhibits the late inward sodium current and reduces the deleterious effects of intracellular sodium and calcium overload that accompany myocardial ischemia. 262 Ranolazine is currently indicated for treatment of chronic angina.…”

Section: Ranolazinementioning

confidence: 99%

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

Amsterdam¹,

Wenger²,

Brindis³

et al. 2014

Circulation

1,099

908

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Section: Ranolazinementioning

confidence: 99%

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

Amsterdam¹,

Wenger²,

Brindis³

et al. 2014

Circulation

1,099

908

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“…Sixth, we restricted our analysis to medications given in the peri-procedural setting or hospital discharge to be consistent with prior studies. 3-5, 28 Evaluation of contraindicated medication use throughout the hospital stay is an area for future research. Seventh, medication allergies and adverse events were not assessed as potential reasons for contraindicated antiplatelet medication use.…”

Section: Discussionmentioning

confidence: 99%

Use of Contraindicated Antiplatelet Medications in the Setting of Percutaneous Coronary Intervention

Barnes

Stanislawski²,

Liu³

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background Several antiplatelet medications used during and after percutaneous coronary intervention (PCI) are contraindicated for specific patient groups. A broad assessment of contraindicated medication use and associated clinical outcomes is not well described. Methods and Results Using national VA CART Program data for all PCI between 2007-2013, we evaluated patients with contraindications to commonly used antiplatelet medications during and after PCI, defined in accordance with package inserts. Adjusted association between contraindicated medication use and outcomes of periprocedural bleeding and 30-day mortality were assessed using Cox proportional hazards with inverse probability weighting. Among 64,294 patients undergoing PCI, 11,315(17.6%) had a contraindication to a common antiplatelet medication and 737 (6.5%) of these patients received a contraindicated medication. In unadjusted analyses, any contraindicated medication use was associated with both increased bleeding and 30-day mortality. In adjusted models, contraindicated abciximab use in patients with thrombocytopenia (HR 2.23, 95% CI 1.58-3.16) and in patients with a prior stroke (HR 1.93, 95% CI 1.37-2.71) remained significantly associated with increased bleeding. Contraindicated abciximab use was not significantly associated with 30-day mortality in adjusted models. Use of eptifibatide in dialysis patients was not significantly associated with an increased risk of bleeding or mortality. Conclusions In this national cohort, about 18% of patients undergoing PCI had contraindications to common antiplatelet medications. Approximately 6% of those patients received a contraindicated medication with attendant bleeding risk, although this did not translate into significantly higher risk of 30-day mortality. Continued efforts to reduce contraindicated medication use may help avoid periprocedural complications.

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Thrombin inhibitors, direct

2016

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Incidence of Bleeding in Renally Impaired Patients Receiving Incorrectly Dosed Eptifibatide or Bivalirudin While Undergoing Percutaneous Coronary Intervention

Abstract: Patients receiving incorrectly dosed eptifibatide and bivalirudin are susceptible to adverse bleeding events. The occurrence of incorrect dosing offers an opportunity for pharmacist-driven institutional improvement.

Cited by 6 publications

References 22 publications

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

Use of Contraindicated Antiplatelet Medications in the Setting of Percutaneous Coronary Intervention

Thrombin inhibitors, direct

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