Dialysis Patients Often Given Wrong Antithrombotics for PCI

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Researchers who studied a group of dialysis patients undergoing percutaneous coronary intervention (PCI) found that one fifth of them received antithrombotic medications that were contraindicated or not recommended for use.

The patients who received these drugs had a significantly elevated risk of in-hospital major bleeding and possibly death, investigators reported in the Journal of the American Medical Association (2009;302:2458-2464).

Thomas T. Tsai, MD, MSc, of the Denver VA Medical Center, and his colleagues examined data from 829 U.S. hospitals on 22,778 dialysis patients who underwent PCI between January 1, 2004 and August 31, 2008. They looked specifically at the use of eptifibatide and enoxaparin, both of which are predominately renally cleared. Eptifibatide is contraindicated in dialysis patients because of increased bleeding risk and enoxaparin is not recommended in dialysis patients because of the risk of bleeding complications, the authors noted.

Of the 22,778 patients, 5,084 (22.3%) received one or both of these antithrombotic agents. In adjusted analyses, patients who received contraindicated antithrombotic drugs had a significant 66% increased risk of major in-hospital bleeding and a 24% increased risk of death.

“Because non-renally cleared antithrombotic alternatives are available, this study supports avoiding the use of enoxaparin and eptifibatide in dialysis patients undergoing PCI,” the authors concluded. “Educational efforts targeting clinicians who prescribe these medications and quality improvement interventions, such as amending clinical pathway order sets to include consideration of renal function, are urgently needed.”

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