ABSTRACT
Interprofessional education (IPE) activities are recommended to reflect current and future practice. The opioid epidemic is one of the most significant current health challenges; recently declared a United States public health crisis. Thus, an IPE program centered on interprofessional roles in pain management during the opioid crisis was developed at the Eugene Applebaum College of Pharmacy and Health Sciences. Professional students from pharmacy, physical therapy, occupational therapy, physician assistant, and nurse anesthesia programs were included. The program included a lecture about each profession, small group case-based problem-solving sessions (group activity), and a panel discussion led by representative pain management experts from each profession. We conducted a retrospective review of data from 251 professional students attending the IPE program, and assessed students' knowledge of each profession and their respective roles in pain management. We evaluated interprofessional skills using the Interprofessional Collaborative Competency Attainment Survey and gathered qualitative student feedback. Participants gained knowledge about other professions. Each represented profession had improvements in five constructs related to interprofessional skills. Students found the most value from the group activity, which encouraged interaction among professions. Overall, the program design was effective in enhancing student knowledge and attitudes regarding collaborative interprofessional team skills.
Subject(s)
Interprofessional Education , Interprofessional Relations , Humans , Pain Management , Problem Solving , StudentsABSTRACT
Objective. To evaluate the metacognitive abilities of pharmacy students and determine whether introducing the concept along with team-based learning (TBL) enhances metacognition.Methods. Pharmacy students completed a Metacognitive Awareness Inventory (MAI) and a low-stakes pretest during the first class that evaluated students' knowledge about the therapeutic concepts that would be taught through TBL. The same questions were administered on the comprehensive final examination for the course. For each of the course assessments, students were asked to indicate their understanding of the topic and predict their performance. Actual performance was measured as a result of each assessment.Results. The pre-MAI composite score was 77.3%. Scores significantly improved by the end of the course to 84.6%. There were significant differences in both declarative knowledge and conditional knowledge when evaluating performance groups. Students in the middle performance group demonstrated the greatest ability to predict their performance on the final examination. Though these were not significant, students in the low group overestimated their performance, while students in the high group underestimated their performance. Baseline grade point average was the only factor predictive of the final examination score and the final course grade.Conclusion. Pedagogies such as TBL may support development of metacognitive skills in pharmacy students. However, intentional guidance provided by an instructor is required to improve pharmacy students' regulation of cognition skills.
Subject(s)
Education, Pharmacy , Metacognition , Students, Pharmacy , Cognition , Humans , KnowledgeABSTRACT
PURPOSE: The purpose of this study was to assess the understandability, actionability, and readability of online diabetes education materials. SUMMARY: This was a descriptive study that identified printable diabetes education materials through an online search. Materials were included from the following sources: national organizations with materials approved by expert panels, corporations with materials subject to FDA approval, and not-for-profit organizations with inter-professional advisory boards to approve materials. Topics included were basic knowledge of diabetes, hypoglycemia, insulin, and blood sugar goals. Materials were excluded if they were non-printable, contained active links, had a publication date prior to January 2011, were greater than 2 pages in length, or were pediatric focused. Understandability and actionability of the patient education materials were evaluated using the Patient Education Materials Assessment Tool (PEMAT). Descriptive statistics and inter-rater reliability analysis using the kappa statistic were utilized. Readability was assessed using the Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook (SMOG) formula. Pearson correlation coefficient was calculated to assess the relationship between reading grade level and PEMAT scores. In total, 25 websites were identified, 5 of which met the inclusion criteria; 13 patient education materials were included, PEMAT scoring revealed that 4 of these met the criteria for understandability and only 1 met the criteria for actionability. There was no correlation found between PEMAT scores and reading grade levels (Pearson correlation coefficient = -0.30, p = 0.325). CONCLUSION: The majority of diabetes patient education materials reviewed scored poorly using the PEMAT. Future development of diabetes patient education materials should be designed with the goal of increasing understandability and actionability.
Subject(s)
Comprehension , Diabetes Mellitus , Internet , Patient Education as Topic , Health Literacy , Humans , Reproducibility of ResultsABSTRACT
BACKGROUND: Many studies have shown the positive impact that student pharmacists have on patients' health; however, no studies have been published evaluating student pharmacists' impact on direct patient outcomes (ie, readmission, emergency department [ED] visits, length of stay) related to the medication history process. OBJECTIVE: To evaluate the impact of student pharmacist-obtained medication histories on identification of medication discrepancies and clinical outcomes. METHODS: Student pharmacists obtained medication histories and then compared the history to that obtained by other health-care providers. Students documented discrepancies and interventions were completed. Control patients were identified and discharge medication list and 30-day readmissions were compared. RESULTS: Seventeen students conducted 215 patient interviews, and 1848 modifications were made to documented home medications in the electronic medical record. Compared to controls (n = 148 student pharmacist, 149 controls), a nonsignificant improvement was found in discharge medication list completeness scores in patients seen by student pharmacists (3.94 vs 3.63; P = .06); but no difference was found in accuracy scores (0.92 vs 0.93; P = .41). Fewer ED visits at 30 days were found in the student pharmacist group (8 vs 18; P = .045), with no difference in readmissions. CONCLUSIONS: Student pharmacist-obtained medication histories improved the information available for identifying drug-related problems for inpatients, completeness of the discharge medication list, and ED visits within 30 days.
Subject(s)
Medication Reconciliation/standards , Pharmacy Service, Hospital/organization & administration , Students, Pharmacy , Academic Medical Centers , Adult , Aged , Aged, 80 and over , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Male , Middle Aged , Patient Readmission/statistics & numerical data , Professional Role , Retrospective StudiesABSTRACT
In 2011 we reviewed clinical updates and controversies surrounding anticoagulation bridge therapy in patients with atrial fibrillation (AF). Since then, options for oral anticoagulation have expanded with the addition of four direct oral anticoagulant (DOAC) agents available in the United States. Nonetheless, vitamin K antagonist (VKA) therapy continues to be the treatment of choice for patients who are poor candidates for a DOAC and for whom bridge therapy remains a therapeutic dilemma. This literature review identifies evidence and guideline and consensus statements from the last 5 years to provide updated recommendations and insight into bridge therapy for patients using a VKA for AF. Since our last review, at least four major international guidelines have been updated plus a new consensus document addressing bridge therapy was released. Prospective trials and one randomized controlled trial have provided guidance for perioperative bridge therapy. The clinical trial data showed that bridging with heparin is associated with a significant bleeding risk compared with not bridging; furthermore, data suggested that actual perioperative thromboembolic risk may be lower than previously estimated. Notably, patients at high risk for stroke have not been adequately represented. These findings highlight the importance of assessing thrombosis and bleeding risk before making bridging decisions. Thrombosis and bleeding risk tools have emerged to facilitate this assessment and have been incorporated into guideline recommendations. Results from ongoing trials are expected to provide more guidance on safe and effective perioperative management approaches for patients at high risk for stroke.
Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Stroke/prevention & control , Administration, Oral , Anticoagulants/adverse effects , Atrial Fibrillation/epidemiology , Clinical Trials as Topic/methods , Heparin/administration & dosage , Heparin/adverse effects , Humans , Practice Guidelines as Topic/standards , Prospective Studies , Risk Factors , Stroke/epidemiologyABSTRACT
A variety of changes are facing leaders in academic pharmacy. Servant and transformational leadership have attributes that provide guidance and inspiration through these changes. Servant leadership focuses on supporting and developing the individuals within an institution, while transformational leadership focuses on inspiring followers to work towards a common goal. This article discusses these leadership styles and how they may both be ideal for leaders in academic pharmacy.
Subject(s)
Education, Pharmacy/organization & administration , Leadership , GoalsABSTRACT
Objective. To evaluate a flipped drug literature evaluation course for first-year pharmacy students. Design. A drug literature evaluation course was flipped during the 2014 winter semester. Homework from 2013 was transformed into activities and lectures were transformed into multiple short YouTube videos. Assessment. Average examination scores increased from 75.6% to 86.1%. Eighty-two of 94 students completed the postcourse survey in 2014. Compared to traditional lecture, 59.8% of students indicated they preferred the flipped course. Additionally, students felt the course was important, the in-class activities were helpful, and some of the YouTube videos could be improved. We found length of the video to be significantly correlated with the percentage of videos viewed. Conclusion. The flipped model should be considered in drug literature evaluation courses that seek to increase the amount of active learning in the classroom.
Subject(s)
Curriculum/standards , Education, Pharmacy/standards , Medicine in Literature , Pharmaceutical Preparations , Problem-Based Learning/standards , Education, Pharmacy/methods , Educational Measurement/methods , Educational Measurement/standards , Humans , Problem-Based Learning/methods , Students, Pharmacy , Surveys and QuestionnairesABSTRACT
BACKGROUND: Hospitalized patients with elevated blood pressure (BP) in most cases should be treated with intensification of oral regimens, but are often given intravenous (IV) antihypertensives. OBJECTIVE: To determine frequency of prescribing and administering episodic IV antihypertensives and outcomes. DESIGN: Retrospective review. SETTING: Urban academic hospital. PATIENTS: Non-critically ill, hospitalized patients with an IV antihypertensive order for enalaprilat, labetalol, hydralazine, or metoprolol. MEASUREMENTS: We analyzed BP thresholds for ordering and administering IV antihypertensives, the types and frequencies of IV antihypertensives administered, and the effect of IV antihypertensive use on short-term BP and adverse outcomes. The BP change during hospitalization was contrasted in those receiving IV antihypertensives between those who did and did not receive subsequent intensification of chronic oral antihypertensive regimens. RESULTS: Two hundred forty-six patients had an episodic IV antihypertensive order. One hundred seventy-two patients received 458 doses, with 48% receiving a single dose. Over 98% of episodic IV antihypertensive doses were administered for systolic blood pressure (SBP) <200 mm Hg and 84.5% for SBP <180 mm Hg. Within 6 hours of administration, there was a statistically significant decline in average SBP and diastolic BP in patients receiving IV hydralazine and labetolol. After administration of IV antihypertensives, the oral inpatient medication regimen was adjusted in 52% of patients; these patients had a greater reduction in SBP from admission to discharge than patients with no change to their oral regimens. A total of 32.6% of patients receiving treatment experienced a BP reduction of more than 25% within 6 hours. CONCLUSIONS: IV antihypertensive drugs are ordered and administered in patients with asymptomatic, uncontrolled BP for levels unassociated with substantive immediate cardiovascular risk, which may cause adverse effects.
Subject(s)
Administration, Intravenous/statistics & numerical data , Antihypertensive Agents/administration & dosage , Hypertension/drug therapy , Administration, Oral , Aged , Antihypertensive Agents/adverse effects , Blood Pressure/drug effects , Female , Hospitalization , Humans , Hypotension/chemically induced , Male , Middle Aged , Practice Patterns, Physicians' , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVE: To enhance academic performance and student progression by creating a community of learners. DESIGN: Academic performance and student progression of students participating in the first 3 years of a second-year pharmacy learning community were compared with those of students in the 3 previous classes. Students participating in the learning community completed surveys at the end of each semester and at the end of the academic year. Peer mentors were surveyed at the end of the academic year. ASSESSMENT: After implementing the learning community, failures during the second year of the pharmacy program decreased. Students had increasingly positive perceptions of the experience over the 3 years. Peer mentors rated their overall experience highly. CONCLUSION: Implementation of a learning community resulted in improved progression through the program and was well received by students.
Subject(s)
Education, Pharmacy/methods , Educational Status , Female , Humans , Learning , Male , Mentors , Peer Group , Program Development/methods , Residence Characteristics , Students, PharmacyABSTRACT
PURPOSE: The literature surrounding health literacy and its importance in everyday practice are reviewed. SUMMARY: Health literacy includes a patient's reading, writing, and numeracy skills, as well as his or her cultural experiences, understanding of health concepts and pathophysiology, and basic communication skills. Over one third of the American population lack the skills necessary to understand health information, make health care decisions, or follow medication instructions. Independent risk factors for low health literacy include poor socioeconomic status, ethnicity, older age, and limited education. Mounting evidence suggests that low health literacy leads to poor health outcomes, increased mortality, increases in health care costs, and poorly self-managed chronic diseases. Communication with a pharmacist to gain clarification of medication instructions is often the last opportunity to ensure that patients understand how to use their medications appropriately. Low health literacy is not always easily recognized, as patients use well-practiced coping mechanisms or avoidant behaviors. Clear communication strategies help patients become more involved in their care plans and increase positive interactions. Tools to assess health literacy have been developed and can be used by pharmacists to guide education and counseling. Advanced methods of written and oral communication should be used to improve patient comprehension and understanding. CONCLUSION: Tools such as simple word-recognition tests or comprehensive tests of functional health literacy can be used in daily practice to assess patients' health literacy. Being familiar with communication techniques such as the Indian Health Service, teach back, and Ask Me 3 can help facilitate individualized medication-related education and maximize patient comprehension.
Subject(s)
Health Literacy/methods , Patient Education as Topic/methods , Pharmacists , Professional Role , Professional-Patient Relations , HumansABSTRACT
Aspirin has been used for the prevention and treatment of cardiovascular disease (CVD) for several decades. The efficacy of aspirin for secondary prevention of cardiovascular disease is well established, but the clinical benefit of aspirin for primary prevention of CVD is less clear. The primary literature suggests that aspirin may provide a reduction in CVD events, but the absolute benefit is small and accompanied by an increase in bleeding. For aspirin to be beneficial for an individual patient, the risk of a future CVD event must be large enough to outweigh the risk of bleeding. The estimation of CVD risk is multifaceted and can involve numerous risk scores and assessments of concomitant comorbidities that confer additional CVD risk. Numerous guidelines provide recommendations for the use of aspirin for primary prevention, but they often contradict one another despite being based on the same clinical trials. Additional literature suggests that the presence of comorbidities that increase CVD risk, such as diabetes mellitus, asymptomatic peripheral arterial disease, or chronic kidney disease, does not ensure that aspirin therapy will be beneficial. Ongoing clinical trials may provide additional insight, but until more data are available, an individualized assessment of CVD risk with careful evaluation of risk and benefit should be performed before recommending aspirin therapy for primary prevention of CVD.
Subject(s)
Aspirin/therapeutic use , Cardiovascular Diseases/prevention & control , Cyclooxygenase Inhibitors/therapeutic use , Evidence-Based Medicine , Platelet Aggregation Inhibitors/therapeutic use , Primary Prevention , Aspirin/adverse effects , Cardiovascular Diseases/epidemiology , Cyclooxygenase Inhibitors/adverse effects , Female , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Humans , Male , Meta-Analysis as Topic , Platelet Aggregation Inhibitors/adverse effects , Practice Guidelines as Topic , Randomized Controlled Trials as Topic , Risk , Sex CharacteristicsABSTRACT
Long-term anticoagulation with a vitamin K antagonist (VKA) or the new agent dabigatran is recommended to decrease stroke risk in patients with atrial fibrillation. When patients with atrial fibrillation undergo initiation or interruption of VKA therapy, or experience an isolated subtherapeutic international normalized ratio (INR), bridge therapy with a parenteral anticoagulant may be considered. To describe the literature for anticoagulation bridge therapy in patients with atrial fibrillation, we conducted a MEDLINE search (1966-February 2011) of the English-language literature to identify related studies. Ongoing clinical trials were identified through a search of the ClinicalTrials.gov registry. Major national and international guidelines were gathered and evaluated. Additional literature was obtained through review of relevant references of the identified articles. Bridging is not supported by guidelines or clinical trials for patients starting VKA therapy for atrial fibrillation. A subtherapeutic INR value during long-term VKA therapy may be associated with increased thromboembolic events, but the benefit of bridging has not been demonstrated. When VKA therapy is interrupted for procedures, retrospective and cohort data suggest that the decision to bridge should be based on a patient's thromboembolic and bleeding risks associated with the procedure. Typically, it is recommended to use bridge therapy in patients with atrial fibrillation at high risk for thromboembolism, but the benefit of bridging is less clear in patients at low risk. Not all procedures necessitate anticoagulation interruption. Recent trials suggest that VKAs can be continued when patients are undergoing cardiac device procedures and some types of radiofrequency ablation. Several clinical trials are ongoing that will provide more definitive guidance for perioperative anticoagulation management of patients with atrial fibrillation. Patients taking dabigatran are unlikely to require bridge therapy because of a predictable anticoagulant effect and rapid onset of action. However, evidence for optimal perioperative management of dabigatran is needed.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Stroke/prevention & control , Anticoagulants/adverse effects , Anticoagulants/pharmacology , Atrial Fibrillation/complications , Benzimidazoles/adverse effects , Benzimidazoles/pharmacology , Benzimidazoles/therapeutic use , Dabigatran , Humans , International Normalized Ratio , Perioperative Care/methods , Stroke/etiology , Thromboembolism/etiology , Thromboembolism/prevention & control , Vitamin K/antagonists & inhibitors , beta-Alanine/adverse effects , beta-Alanine/analogs & derivatives , beta-Alanine/pharmacology , beta-Alanine/therapeutic useABSTRACT
Elevated blood pressure during the acute stroke period is associated with poor neurologic outcomes; however, treating blood pressure in this setting remains controversial. Interest in modulating the renin-angiotensin system in this setting has gained momentum because of neurohormonal properties, which may provide benefits beyond blood pressure control. The Scandinavian Candesartan Acute Stroke Trial (SCAST) was recently published describing the effects of candesartan in patients with hypertension during the acute stroke period. This study shows that lowering blood pressure with an ARB for 7 days poststroke does not improve 6-month neurologic outcomes. This article provides a context for a continuing discussion regarding the role of blood pressure lowering in patients following acute stroke.
ABSTRACT
INTRODUCTION: Antithrombotic therapy plays an integral role in percutaneous coronary intervention (PCI). Bivalirudin has been evaluated in elective procedures and across the spectrum of acute coronary syndromes and is associated with decreased bleeding events compared to unfractionated heparin (UFH) in combination with glycoprotein IIb/IIIa inhibitors (GPI) when used for the duration of PCI. The use of bivalirudin beyond the end of PCI is not as well established but is being explored as an option for specific patients. DISCUSSION: A small increase in stent thrombosis and ischemic events has been identified in large clinical trials using bivalirudin for acute coronary syndromes (ACS). The reasons for this finding are unclear, but may be related to the short duration of bivalirudin or the timing and dose of antiplatelet therapies in the trials. Two small, single center trials have evaluated bivalirudin continued for 4 h beyond the end of PCI. These trials suggest that prolonged bivalirudin infusions result in less periprocedural myocardial infarction with no increase in bleeding compared to intraprocedural only bivalirudin. However, these studies were not powered to identify a difference in bleeding. Efforts to decrease periprocedural myocardial infarction should include the appropriate use of oral antiplatelet agents. An adequate and appropriately timed loading dose of thienopyridines plays a key role in decreasing complications of PCI. CONCLUSION: The strategy of prolonging the bivalirudin infusion at a reduced infusion rate for 4 h after completion of the PCI procedure was explored and offers promising results.
Subject(s)
Angioplasty, Balloon, Coronary/methods , Antithrombins/therapeutic use , Peptide Fragments/therapeutic use , Acute Coronary Syndrome/therapy , Antithrombins/administration & dosage , Dose-Response Relationship, Drug , Hirudins/administration & dosage , Humans , Peptide Fragments/administration & dosage , Recombinant Proteins/administration & dosage , Recombinant Proteins/therapeutic use , Stents , Thrombosis/epidemiology , Thrombosis/etiology , Time FactorsABSTRACT
OBJECTIVE: To review the available literature on the efficacy and safety of low-molecular-weight heparin (LMWH) in the treatment of ST-elevation myocardial infarction (STEMI) in patients treated with fibrinolytic therapy or conservative medical management. DATA SOURCES: A MEDLINE search (1966-March 2004) using the key words myocardial infarction, STEMI, LMWH, enoxaparin, and dalteparin identified pertinent articles. The references of these articles were reviewed for additional pertinent references. STUDY SELECTION AND DATA EXTRACTION: All human trials of LMWH in STEMI were evaluated. All pertinent studies were included in the review. DATA SYNTHESIS: LMWH did not show a benefit in STEMI without fibrinolytic therapy. Enoxaparin is similar to intravenous unfractionated heparin (UFH) in combination with nonspecific fibrinolytic therapy with regard to invasive reperfusion markers and 30-day clinical outcomes. Enoxaparin decreases composite endpoints in combination with fibrin-specific fibrinolytic therapy compared with UFH, primarily through a reduction in the incidence of reinfarction at 30 days. Bleeding rates with LMWH in combination with fibrinolytic agents are not greater than those with UFH. CONCLUSIONS: Enoxaparin is a reasonable alternative to UFH in patients with STEMI treated with fibrin-specific fibrinolytic therapy. LMWH in patients managed with nonspecific fibrinolytic therapy or conservative medical treatment does not provide an advantage over standard management. Large clinical trials are ongoing which will provide more definitive recommendations.
Subject(s)
Anticoagulants/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Myocardial Infarction/drug therapy , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Drug Therapy, Combination , Electrocardiography , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/administration & dosage , Heparin, Low-Molecular-Weight/adverse effects , Humans , Myocardial Infarction/classification , Myocardial Infarction/physiopathology , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVE: To review the available literature addressing the role of low-molecular-weight heparin (LMWH) as an alternative to unfractionated heparin (UFH) in percutaneous coronary intervention (PCI) for treatment of non-ST-elevation acute coronary syndromes (NSTEACS). DATA SOURCES: A MEDLINE search (1966-March 2004) identified pertinent articles using the key words acute coronary syndromes, unstable angina, non-ST-elevation myocardial infarction, low-molecular-weight heparin, enoxaparin, dalteparin, glycoprotein IIb/IIIa receptor antagonists, abciximab, tirofiban, eptifibatide, percutaneous transluminal coronary angioplasty, and percutaneous coronary intervention. The references of these articles were reviewed for additional pertinent references. STUDY SELECTION AND DATA EXTRACTION: All human trials of LMWH in PCI for treatment of NSTEACS were evaluated. All pertinent studies were included in the review. DATA SYNTHESIS: Administration of LMWH with or without a glycoprotein IIb/IIIa inhibitor during PCI appears to be similar to UFH in terms of efficacy. LMWH, especially in combination with a glycoprotein IIb/IIIa inhibitor, may increase risk of bleeding compared with UFH. CONCLUSIONS: Available clinical trials do not provide definitive evidence to suggest superiority of LMWH over UFH when managing NSTEACS during PCI; however, dosing strategies are available if an LMWH is to be used in this setting.
Subject(s)
Coronary Disease/drug therapy , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Acute Disease , Angioplasty, Balloon, Coronary , Coronary Disease/physiopathology , Coronary Disease/surgery , Fibrinolytic Agents/adverse effects , Fibrinolytic Agents/pharmacology , Heparin/adverse effects , Heparin/pharmacology , Heparin/therapeutic use , Heparin, Low-Molecular-Weight/adverse effects , Heparin, Low-Molecular-Weight/pharmacology , Humans , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Randomized Controlled Trials as TopicABSTRACT
The safety of glycoprotein (GP) IIb/IIIa inhibitors has been well documented in clinical trials. Although these trials have included a broad patient population, the strict enrollment criteria may have resulted in exclusion of patients at a higher risk of bleeding complications. The authors conducted a retrospective chart review of 1020 consecutive patients who received GP IIb/IIIa inhibitors and underwent percutaneous coronary intervention in a large community hospital. They used Thrombolysis in Myocardial Infarction (TIMI) criteria to define major or minor bleeding complications. Bleeding complications developed in 214 (21%) patients, with major bleeding in 89 (9%). Univariate predictors of bleeding were older age, lower body weight, elevated serum creatinine, higher activated partial thromboplastin time (aPTT) level, history of diabetes mellitus (DM), peripheral vascular disease (PVD), congestive heart failure (CHF), and emergency procedure for acute myocardial infarction (AMI). Multivariate predictors of major bleeding were PVD (20% in bleeding group vs 11% in nonbleeders, odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.2-2.6, P < .004), age (68 +/- 2 years, 95% CI = 66-70 in bleeding group vs 63 +/- 13 years, 95% CI = 61.2-63 in nonbleeders, P < .001), and higher aPTT level (66 +/- 27 seconds, 95% CI = 63-70 in bleeding group vs 53 +/- 28 seconds, 95% CI = 51-56 in nonbleeders, P < .001). The risk of bleeding in the large community hospital setting may be higher than in randomized clinical trials. This increased risk is associated with higher hospitalization costs. Recognition of predictors of bleeding should further enhance the safety of these antiplatelet agents.
Subject(s)
Angioplasty, Balloon, Coronary , Hemorrhage/chemically induced , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Female , Hemorrhage/epidemiology , Hospitals, Community , Humans , Male , Retrospective Studies , RiskABSTRACT
The safety of adjunct eptifibatide in the setting of rescue angioplasty (PTCA) with or without stenting after full-dose thrombolytic therapy is not well defined. Our study was undertaken to assess the risk of hemorrhagic complications following use of eptifibatide in patients undergoing rescue PTCA/stenting following failed thrombolysis. Clinical records of 43 consecutive patients (53% males) who received eptifibatide during rescue PTCA/stenting following full-dose fibrinolytic therapy were reviewed. Data were collected for: timing of rescue PTCA following fibrinolytic use; concomitant use of other antiplatelet agents; hospital length of stay; in-hospital mortality; and incidence of bleeding complications. Bleeding complications were categorized as major or minor according to Thrombolysis in Myocardial Infarction (TIMI) study group criteria. Overall bleeding complications developed in 13 patients (30%), with 4 patients (9%) experiencing major bleeding. Univariate predictors of major bleeding complications were: older age; female sex; lower baseline platelet count; and time to initiation of eptifibatide following failed thrombolysis. On multivariate analysis, the only predictors of bleeding were gender (27% in females versus 3% in males; odds ratio, 1.7; 95% confidence interval, 0.1-0.9) and time to initiation of eptifibatide following failed thrombolysis (4.6 +/- 2 hours versus 11 +/- 9 hours; p<0.04; 95% confidence interval, 2.1-11.4). Use of potent antiplatelet agents during rescue PTCA/stenting results in an increased risk of bleeding. Careful attention to predictors of bleeding and, in particular, delaying eptifibatide administration following full-dose fibrinolytic use may result in the reduction of major and minor bleeding complications.