Consultations for drug-related bleeding at the Emergency Unit of the Asociación Española Primera de Socorros Mutuos
Keywords:
PHARMACEUTICAL PREPARATIONS, HEMORRHAGEAbstract
Introduction: during 2007, adverse drug reaction (ADR) determined 4.1% of hospitalizations at Asociación Española Primera de Socorros Mutuos (AEPSM). Gastrointestinal bleeding associated to non-steroidal anticoagulants (NSAID) was a frequent problem.
Objectives:to determine frequency and characteristics of patients who consult for bleeding or alterations in blood crasis associated to drugs, or both, at the Emergency Unit of the AEPSM.
Method: the study analysed all consultations due to bleeding or crasis alterations, or both, at the emergency service between March 24 and April 23, 2008. Those complying with the diagnostic criteria of bleeding or INR alterations were included. The following variables were analysed: age, sex, drugs implied, type of bleeding and severity.
Results: 30 patients (0.45%; IC95% 0.42-0.47) consulted for adverse drug reaction, and 20% of them were hospitalized (1.27%; IC95% 1.30-1.24). ADR were related to anticoagulants (n=19) and non-steroidal anti-inflammatory drugs (n=11). In the ADR due to anticoagulants, average age was 77 and the most frequent drug was warfarina. 15 patients presented five or more concomitant drugs and one patient died. In the ADR group with non-steroidal anti-inflammatory drugs average age was 69, and the most frequent drug was acetylsalicylic acid, eight patients presented polypharmacy and four patients evidenced self-medication.
Conclusions: drug related bleeding constitutes a serious health problem. In most cases it takes place in patients with risk factors for developing a disease resulting from drugs. We need to plan strategies with the purpose of diminishing the impact of this problem.
References
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(35) de Abajo FJ, García-Rodríguez LA. Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid-suppressing agents. Arch Gen Psychiatry 2008; 65(7): 795-803.
(2) Cunningham G, Dodd TR, Grant DJ, McMurdo ME, Richards RM. Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Age Ageing 1997; 26(5): 375-82.
(3) Doucet J, Chassagne P, Trivalle C, Landrin I, Pauty MD, Kadri N, et al. Drug-drug interactions related to hospital admissions in older adults: a prospective study of 1000 patients. J Am Geriatr Soc 1996; 44(8): 944-8.
(4) Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279(15): 1200-5.
(5) Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18820 patients. BMJ 2004; 329(7456): 15-9.
(6) Giachetto G, Danza A, Lucas L, Cristiani F, Cuñetti L, Vázquez X, et al. Hospitalizaciones por reacciones adversas a medicamentos y abandono del tratamiento farmacológico en el hospital universitario. Rev Méd Urug 2008; 24(2): 102-8.
(7) Olmos V, Giachetto G, Olmos I, Daners M. Hospitalizations for adverse drug reactions in a private non-profit hospital, Montevideo, Uruguay. HPS eNewsletter 14 August 2009: 10-3.
(8) Laporte JR, Ibáñez L, Vidal X, Vendrell L, Leone R. Upper gastrointestinal bleeding associated with the use of NSAIDs: newer versus older agents. Drug Safety 2004; 27(6): 411-20.
(9) Laporte JR, Carné X. Metodología epidemiológica básica en farmacovigilancia. In: Laporte JR, Tognoni G, eds. Principios de epidemiología del medicamento. 20ª. ed. Barcelona: Masson-Salvat, 1993: 111-30.
(10) World Health Organization. Requirements for adverse reaction reporting. Geneva: WHO, 1975.
(11) Flórez J, ed. Farmacología humana. 3ª. ed. Barcelona: Masson, 1997.
(12) Kanjanarat P, Winterstein AG, Johns TE, Hatton RC, Gonzalez-Rothi R, Segal R. Nature of preventable adverse drug events in hospitals: a literature review. Am J Health Syst Pharm 2003; 60(17): 1750-9.
(13) Almut G, Hatton, González-Rothi, E. Johns, Richard Segal. Identifying significant preventable adverse drug events: methods. Am J Health Syst Pharm 2002; 59(18): 14.
(14) Schumock GT, Thornton JP. Focusing on the preventability of adverse drug reactions. Hosp Pharm 1992; 27(6): 538.
(15) Decreto 57/2006. Disponible en: http://www.presidencia.gub.uy/_web/MEM_2006/MSP.pdf. Consulta: 25 julio 2010.
(16) Beyth RJ, Shorr RI. Epidemiology of adverse drug reactions in the elderly by drug class. Drugs Aging 1999; 14(3): 231-9.
(17) Pouyanne P, Haramburu F, Imbs JL, Bégaud B. Admissions to hospital caused by adverse drug reactions: cross sectional incidence study. French Pharmacovigilance Centres. BMJ 2000; 320(7241): 1036.
(18) Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1997; 277(4):301-6.
(19) Levine MN, Raskob G, Beyth RJ, Kearon C, Schulman S. Hemorrhagic complications of anticoagulant treatment: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(3 Suppl): 287S-310S.
(20) Gandhi TK, Burstin HR, Cook EF, Puopolo AL, Haas JS, Brennan TA, et al. Drug complications in outpatients. J Gen Intern Med 2000; 15(3): 149-54.
(21) Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003; 289(9): 1107-16.
(22) Delafuente JC. Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol 2003; 48(2): 133-43,
(23) Karas S Jr. The potential for drug interactions. Ann Emerg Med 1981; 10(12): 627-30.
(24) Martin RM, Biswas PN, Freemantle SN, Pearce GL, Mann RD. Age and sex distribution of suspected adverse drug reactions to newly marketed drugs in general practice in England: analysis of 48 cohort studies. Br J Clin Pharmacol 1998; 46(5): 505-11.
(25) Budnitz DS, Shehab N, Kegler SR, Richards CL. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007; 147(11): 755-65.
(26) Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 2008; 27(1): 31-40.
(27) Wallerstedt SM, Gleerup H, Sundström A, Stigendal L. Risk of clinically relevant bleeding in warfarin-treated patients-influence of SSRI treatment. Pharmacoepidemiol Drug Saf 2009; 18(5): 412-6.
(28) Schalekamp T, Klungel OH, Souverein PC, de Boer A. Increased bleeding risk with concurrent use of selective serotonin reuptake inhibitors and coumarins. Arch Intern Med 2008; 168(2): 180-5.
(29) Lewis JD, Strom BL, Localio AR, Metz DC, Farrar JT, Weinrieb RM, et al. Moderate and high affinity serotonin reuptake inhibitors increase the risk of upper gastrointestinal toxicity. Pharmacoepidemiol Drug Saf 2008; 17(4): 328-35.
(30) Kerin NZ, Blevins RD, Goldman L, Faitel K, Rubenfire M. The incidence, magnitude, and time course of the amiodarone-warfarin interaction. Arch Intern Med 1988; 148(8): 1779-81.
(31) Lu Y, Won KA, Nelson BJ, Qi D, Rausch DJ, Asinger RW. Characteristics of the amiodarone-warfarin interaction during long-term follow-up. Am J Health Syst Pharm 2008; 65(10): 947-52.
(32) Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health 1999; 23(1): 40-54.
(33) Multidisciplinary Medication Management Project. Top ten dangerous drug interactions in long-term care. Disponible en: http://www.scoup.net/M3Project/topten/index.htm. Consulta: 1 febrero 2003.
(34) Laporte JR, Ibáñez L, Vidal X, Vendrell L, Leone R. Upper gastrointestinal bleeding associated with the use of NSAIDs: newer versus older agents. Drug Saf 2004; 27(6): 411-20.
(35) de Abajo FJ, García-Rodríguez LA. Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid-suppressing agents. Arch Gen Psychiatry 2008; 65(7): 795-803.
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2011-04-30
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Olmos I, Daners M, Olmos V, Giachetto G. Consultations for drug-related bleeding at the Emergency Unit of the Asociación Española Primera de Socorros Mutuos. Rev. Méd. Urug. [Internet]. 2011 Apr. 30 [cited 2024 Nov. 21];27(1):5-11. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/400
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