Several antithrombotic agents commonly used by cardiologists during percutaneous coronary intervention (PCI) are not recommended for use in dialysis patients.\u00a0 Specifically, eptifibatide and enoxaparin are renally excreted and therefore not recommended for use in dialysis patients due to an increased risk of bleeding complications.\u00a0 Tsai and colleagues investigated the use of these agents amongst dialysis patients undergoing coronary intervention and their association with outcomes.\u00a0 The authors used data from 829 US hospitals on 22778 dialysis patients who underwent PCI between 2004 and 2008.\u00a0 The main outcome measure was in-hospital bleeding and death.<\/p>\n
Overall, 5084 patients (22\/3%) received a contra-indicated antithrombotic – 2375 (46\/7%) received enoxaparin, 3261 (64.1%) received eptifibatide, and 552 patients (10.9%) received both.\u00a0 Compared with patients who did not receive a contraindicated antithrombotic, those who did showed higher rates of both in-hospital bleeding (5.6% vs. 2.9%; odds ratio 1.93) and death (6.5% vs. 3.9%; odds ratio 1.68).\u00a0 Following multi-variable adjustment, these risks remained high; odds ratio 1.66 for in-hospital bleeding and\u00a0 1.24 for death for those who received contraindicated antithrombotics.\u00a0 Lastly, in 10158 patients matched using propensity scores, receipt of contraindicated antithrombotics remained significantly associated with in-hospital bleeding (odds ratio 1.63), but not in-hospital death (odds ratio 1.15).<\/p>\n
Conclusions:<\/p>\n
The inappropriate use of eptifibatide and enoxaparin in patients with renal impairment is common.\u00a0 Furthermore, their use in this patient group is associated with a significantly increased risk of in-hospital bleeding.\u00a0 This issue is likely to become of even greater importance as the number of dialysis patients undergoing PCI is increasing.<\/p>\n
\u2022\u00a0\u00a0\u00a0 Tsai TT, Maddoz TM, Roe MT et al.\u00a0 Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention.\u00a0 JAMA 2009; 302:2458-2464.<\/p>\n
Journals scanned
\nAmerican Journal of Medicine; American Journal of Physiology: Heart and Circulatory Physiology; Annals of Emergency Medicine; Annals of Thoracic Surgery; Archives of Internal Medicine; BMJ; Chest; European Journal of Cardiothoracic Surgery; JAMA; Journal of Clinical Investigation; Journal of Diabetes and its Complications; Journal of Immunology; Journal of Thoracic and Cardiovascular Surgery; Lancet; Nature Medicine; New England Journal of Medicine; Pharmacoeconomics; Thorax<\/p>\n
Reviewers
\nDr Alistair C Lindsay, Dr Jonathan Spiro, Dr Hussain Contractor<\/p>\n","protected":false},"excerpt":{"rendered":"
Several antithrombotic agents commonly used by cardiologists during percutaneous coronary intervention (PCI) are not recommended for use in dialysis patients.\u00a0 Specifically, eptifibatide and enoxaparin are renally excreted and therefore not recommended for use in dialysis patients due to an increased risk of bleeding complications.\u00a0 Tsai and colleagues investigated the use of these agents amongst dialysis […]<\/p>\n