Optimisation of antithrombotic therapy in patients with acute coronary syndrome to reduce bleeding episodes.
2016
Summary
Aim
The aim of the study was to evaluate the effectiveness of a multidisciplinary intervention to reduce the risk of bleeding associated with antithrombotic drugs in patients with acute coronary syndrome (ACS).
Methods
We designed a pre–post quasi-experimental intervention study using retrospective cohorts. The first cohort was analysed to detect correctable measures contributing to bleeding (PRE: January–July 2010). Second, a bundle of interventions was implemented and third, a second cohort of patients was evaluated to investigate the impact of our measures in bleeding reduction (POST: September 2011–February 2012).
Results
A total of 677 patients were included (377 in PRE and 300 in POST). The bundle of interventions was:
Overdose avoidance measures: the percentage of patients overdosed was reduced by 66.3% (p < 0.001).
Institutional protocol update to include the latest recommendations regarding bleeding prevention:
In POST, the percentage of patients treated with fondaparinux increased (2.4% vs. 50.7%; p < 0.001).
In PRE, 11 patients were treated with the combination of abciximab and bivalirudin; whereas in POST, only one patient received the combination (p = 0.016).
Mandatory measurement of body weight: the percentage of patients with unknown body weight was reduced by 35% (p = 0.0001).
In POST, the total bleeding rate was reduced by 29.2% (31.6% in PRE vs. 22.4%, p < 0.05, OR: 0.62; 95% CI: 0.44–0.88). It was necessary to implement the interventions in 11 patients to prevent one bleeding episode (95% CI: 7–39).
Conclusion
The multidisciplinary programme has been effective in reducing bleeding episodes. The interventions were effective in reducing antithrombotic drugs overdosage, incorporating the use of fondaparinux to the NSTE-ACS therapeutic arsenal, limiting the use of bivalirudin with abciximab and obtaining body weight for most patients.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
15
References
2
Citations
NaN
KQI