ABSTRACT
BACKGROUND: Bivalirudin, a direct thrombin inhibitor, is a treatment option for the management of heparin-induced thrombocytopenia (HIT) and other coagulation disorders. To date, no published studies have identified patients at risk for or the consequence of subtherapeutic bivalirudin therapy. OBJECTIVES: The primary objective was to identify factors associated with failure to achieve early therapeutic anticoagulation (ETA) with bivalirudin, defined as achievement of two consecutive therapeutic activated partial thromboplastin times (aPTTs) within 24 hours. Secondary objectives included evaluating whether failure to achieve ETA was a risk factor for clinical outcomes of interest including thromboembolism, hemorrhage, and mortality. PATIENTS/METHODS: This was a retrospective cohort study. Patients between the ages of 18 and 89 years treated with bivalirudin for 24 hours or longer were identified and classified as either achieving or failing to achieve ETA. RESULTS: Nonadherence to the dosing protocol (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.07-2.71) and creatinine clearance (CrCl) of 60 ml/min or greater (OR 2.99, 95% CI 1.12-7.97) were significantly associated with failure to achieve ETA in univariate analyses. Conversely, increasing age (OR 0.98, 95% CI 0.97-0.99) was significantly associated with achievement of ETA. Failure to achieve ETA was associated with a 4-fold increase in the odds of thromboembolism. CONCLUSIONS: Younger age, normal renal function, and nonadherence to the dosing protocol when targeting therapeutic anticoagulation is associated with increased risk of failure to achieve ETA. This confers an elevated risk of thromboembolism when using bivalirudin for the management of HIT or other coagulation disorders.
Subject(s)
Antithrombins/administration & dosage , Hirudins/administration & dosage , Peptide Fragments/administration & dosage , Thrombocytopenia/drug therapy , Thromboembolism/prevention & control , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Anthropology, Medical , Antithrombins/adverse effects , Cohort Studies , Female , Hemorrhage/chemically induced , Heparin/adverse effects , Hirudins/adverse effects , Humans , Male , Middle Aged , Partial Thromboplastin Time , Peptide Fragments/adverse effects , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Retrospective Studies , Risk Factors , Thrombocytopenia/chemically induced , Thromboembolism/epidemiology , Treatment Failure , Young AdultABSTRACT
OBJECTIVES: This descriptive study explored whether patients with mental health conditions engage in personal medicine (self-care activities) as part of their treatment regimen. Personal medicine is patient-identified and -initiated activities of self-care that can improve mental health through various means, including physical activity, social engagement, and spiritual connectedness. The purpose of this study was to explore patient engagement in personal medicine within an underserved population and to evaluate the impact self-care might have on self-reported medication use and adherence and patient perception of mental health control. DESIGN: Cross-sectional study design with a face-to-face verbally administered survey assessing medication adherence, engagement in self-care activities, perception of self-care, and mental health control. SETTING: The study site was a nonprofit charitable pharmacy in an urban setting. The pharmacy provides medications and pharmacy services at no charge, including disease state education, point-of-care testing, and medication therapy management. PARTICIPANTS: Study participants included those who fill medications for mental health conditions and who are age 18 years and older. MAIN OUTCOME MEASURES: Main outcomes included engagement in self-care and self-reported medication adherence. Additional measures included stratification of dimensions of self-care, perception of mental health control, and patient knowledge of community resources. RESULTS: Overall, 81.7% of participants engaged in activities of self-care, with 98.3% recognizing self-care as important to improving and maintaining their mental health. Greater self-reported adherence rates and mental health control were seen with patients who participate in self-care. CONCLUSION: Participants who identify and engage in personal medicine recognize its value and are willing to incorporate it into their treatment regimen. As accessible and trusted health care providers, pharmacists can encourage patients to identify and use personal medicine to aid in the improvement of their mental health condition.
