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Adverse drug events related to COX inhibitors in patients presenting at an emergency department

Cross-sectional study of prevalence and risk factors

Zeitschrift:: Notfall + Rettungsmedizin > Ausgabe 8/2016

Autoren:: B. Pfistermeister, Prof. Dr. H. Dormann, A. Patapovas, F. Müller, A. Sonst, H. Glaeser, B. Plank-Kiegele, T. Bürkle, R. Maas

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Wichtige Hinweise

B. Pfistermeister and H. Dormann contributed equally

Abstract

Background

The use of cyclooxygenase (COX) inhibitors is increasingly common. Most of them are available for self-medication, either as analgesic or for cardio- and cerebrovascular prevention.

Objectives

We aimed to analyze adverse drug events (ADE) related to COX inhibitors and the concomitant use of proton pump inhibitors (PPI) according to guidelines in patients presenting at an emergency department (ED).

Methods

In a prospective study, 2262 patients presenting consecutively at the ED of a tertiary care university teaching hospital were evaluated by intensive chart review in order to detect and classify all ADE. In this cross-sectional analysis all patients taking COX inhibitors at home were evaluated further.

Results

Of all evaluated patients, 753 (33.3 %) took COX inhibitors at home, 258 (34.3 %) with concomitant PPI. A total of 168 (22.3 %) patients suffered from at least one ADE related to COX inhibitors. The most common ADE observed were anemia (55.9 %) and gastrointestinal ADE (31.6 %, e. g., bleeding, gastritis, and ulcer). In 10.1 % of patients, a medication error (e. g., intake without proper clinical indication) contributed to the ADE and in 40.8 % of the ADE involved further contributing drugs. Only 38.8–42.1 % of patients with a high gastrointestinal risk were prescribed a PPI concomitantly.

Conclusion

ADE related to COX inhibitors were found in every fifth patient taking COX inhibitors. One-tenth of all ADE involving COX inhibitors were related to medication errors. The guideline-based concomitant use of PPI was only in part implemented.

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Anglin R, Yuan Y, Moayyedi P et al (2014) Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol 109:811–819 CrossRefPubMed

Arasaradnam RP, Woodward T, Parrack L et al (2003) Audit of proton pump inhibitor (PPI) prescribing: are NICE guidelines being followed? Clin Med 3:387–388 CrossRef

Bates DW, Leape LL, Petrycki S (1993) Incidence and preventability of adverse drug events in hospitalized adults. J Gen Intern Med 8:289–294 CrossRefPubMed

Böger R, Schmidt G (2012) Antirheumatika und Antiphlogistika. In: Schwabe U, Paffrath D (eds) Arzneiverordnungs-Report 2012. Springer, Berlin, pp 447–449 CrossRef

Bradley MC, Motterlini N, Padmanabhan S et al (2014) Potentially inappropriate prescribing among older people in the United Kingdom. BioMed Cent Geriatr 14:72

Brun J, Jones R (2001) Nonsteroidal anti-inflammatory drug-associated dyspepsia: the scale of the problem. Am J Med 110:12S–13S CrossRefPubMed

Bürkle T, Müller F, Patapovas A et al (2013) A new approach to identify, classify and count drug-related events. Br J Clin Pharmacol 76(Suppl 1):56–68 CrossRefPubMedPubMedCentral

Capuano A, Motola G, Russo F et al (2004) Adverse drug events in two emergency departments in Naples, Italy: an observational study. Pharmacol Res 50:631–636 CrossRefPubMed

Charlot M, Ahlehoff O, Norgaard ML et al (2010) Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study. Ann Intern Med 153:378–386 CrossRefPubMed

10.

Ctis Common Terminology Criteria for adverse events. https://safetyprofiler-ctep.nci.nih.gov/CTC/CTC.aspx. Accessed 20 November 2013

11.

De Jong HJ, Korevaar JC, Van Dijk L et al (2013) Suboptimal prescribing of proton-pump inhibitors in low-dose aspirin users: a cohort study in primary care. BMJ Open 3(7):e003044 CrossRefPubMedPubMedCentral

12.

Dormann H, Sonst A, Müller F et al (2013) Adverse drug events in older patients admitted as an emergency: the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 110:213–219 PubMedPubMedCentral

13.

Dries AM, Richardson P, Cavazos J et al (2009) Therapeutic intent of proton pump inhibitor prescription among elderly nonsteroidal anti-inflammatory drug users. Aliment Pharmacol Ther 30:652–661 CrossRefPubMed

14.

Fischbach W, Darius H, Gross M et al (2010) Concomitant use of platelet aggregation inhibitors and proton pump inhibitors (PPIs): Position paper of the German Society for Digestive and Metabolic Diseases (DGVS) and the German Society of Cardiology (DGK). Z Gastroenterol 48:1156–1163 CrossRefPubMed

15.

Ghebremariam YT, Lependu P, Lee JC et al (2013) Unexpected effect of proton pump inhibitors: elevation of the cardiovascular risk factor asymmetric dimethylarginine. Circulation 128:845–853 CrossRefPubMed

16.

Gnjidic D, Blyth FM, Le Couteur DG et al (2014) Non-steroidal anti-inflammatory drugs (NSAIDs) in older people: prescribing patterns according to pain prevalence and adherence to clinical guidelines. Pain 155:1814–1820 CrossRefPubMed

17.

Hernández-Díaz S, García Rodríguez LA (2006) Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications. BioMed Cent Med 4:22

18.

Ito T, Jensen RT (2010) Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep 12:448–457 CrossRefPubMedPubMedCentral

19.

Karbach U, Schubert I, Hagemeister J et al (2011) Physicians’ knowledge of and compliance with guidelines: an exploratory study in cardiovascular diseases. Dtsch Arztebl Int 108:61–69 PubMedPubMedCentral

20.

Kirchner M, Bürkle T, Patapovas A et al (2011) Building the technical infrastructure to support a study on drug safety in a general hospital. Stud Health Technol Inform 169:325–329 PubMed

21.

Ladd AM, Panagopoulos G, Cohen J et al (2014) Potential costs of inappropriate use of proton pump inhibitors. Am J Med Sci 347:446–451 CrossRefPubMed

22.

Laine L, Connors L, Griffin MR et al (2009) Prescription rates of protective co-therapy for NSAID users at high GI risk and results of attempts to improve adherence to guidelines. Aliment Pharmacol Ther 30:767–774 CrossRefPubMed

23.

Lanas A, Bajador E, Serrano P et al (2000) Nitrovasodilators, low-dose aspirin, other nonsteroidal antiinflammatory drugs, and the risk of upper gastrointestinal bleeding. N Engl J Med 343:834–839 CrossRefPubMed

24.

Langman MJ, Weil J, Wainwright P et al (1994) Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet 343:1075–1078 CrossRefPubMed

25.

Lanza FL, Chan FK, Quigley EM (2009) Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol 104:728–738 CrossRefPubMed

26.

Masclee GM, Valkhoff VE, Coloma PM et al (2014) Risk for upper gastrointestinal bleeding from different drug combinations. Gastroenterology doi:10.1053/j.gastro.2014.06.007 PubMed

27.

Meier F, Maas R, Sonst A et al (2015) Adverse drug events in patients admitted to an emergency department: an analysis of direct costs. Pharmacoepidemiol Drug Saf 24:176–186 CrossRefPubMed

28.

Müller F, Dormann H, Pfistermeister B et al (2014) Application of the Pareto principle to identify and address drug-therapy safety issues. Eur J Clin Pharmacol 70:727–736 CrossRefPubMed

29.

Nebeker JR, Barach P, Samore MH (2004) Clarifying adverse drug events: a clinician’s guide to terminology, documentation, and reporting. Ann Intern Med 140:795–801 CrossRefPubMed

30.

Patapovas A, Dormann H, Sedlmayr B et al (2013) Medication safety and knowledge-based functions: a stepwise approach against information overload. Br J Clin Pharmacol 76(Suppl 1):14–24 CrossRefPubMedPubMedCentral

31.

Schmiedl S, Rottenkolber M, Hasford J et al (2014) Self-Medication with over-the-counter and prescribed drugs causing adverse-drug-reaction-related hospital admissions: results of a prospective, long-term multi-centre study. Drug Saf 37:225–235 CrossRefPubMed

32.

Sedlmayr B, Patapovas A, Kirchner M et al (2013) Comparative evaluation of different medication safety measures for the emergency department: physicians’ usage and acceptance of training, poster, checklist and computerized decision support. BMC Med Inform Decis Mak 13:79 CrossRefPubMedPubMedCentral

33.

The Uppsala Monitoring Centre The use of the WHO-UMC system for standardised case causality assessment. www.who-umc.org/Graphics/24734.pdf. Accessed 20 November 2013

34.

Tielemans MM, Van Rossum LG, Eikendal T et al (2014) Gastrointestinal symptoms in NSAID users in an ‘average risk population’: results of a large population-based study in randomly selected Dutch inhabitants. Int J Clin Pract 68:512–519 CrossRefPubMed

35.

Varga Z, Kriška M, Kristová V et al (2013) Analysis of non-steroidal anti-inflammatory drug use in hospitalized patients and perception of their risk. Interdiscip Toxicol 6:141–144 CrossRefPubMedPubMedCentral

36.

Vonkeman HE, Fernandes RW, Van De Laar MA (2007) Under-utilization of gastroprotective drugs in patients with NSAID-related ulcers. Int J Clin Pharmacol Ther 45:281–288 CrossRefPubMed

37.

Wallace JL, Syer S, Denou E et al (2011) Proton pump inhibitors exacerbate NSAID-induced small intestinal injury by inducing dysbiosis. Gastroenterology 141:1314–1322 CrossRefPubMed

38.

Wang YP, Chen YT, Tsai CF et al (2014) Short-term use of serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding. Am J Psychiatry 171:54–61 CrossRefPubMed

39.

Yeomans ND, Lanas AI, Talley NJ et al (2005) Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin. Aliment Pharmacol Ther 22:795–801 CrossRefPubMed

40.

Zhang S, Chao GQ, Lu B (2013) Proton pump inhibitors are not the key for therapying non-steroidal anti-inflammatory drugs-induced small intestinal injury. Rheumatol Int 33:2513–2521 CrossRefPubMed

Titel: Adverse drug events related to COX inhibitors in patients presenting at an emergency department
Cross-sectional study of prevalence and risk factors
Autoren:: B. Pfistermeister
Prof. Dr. H. Dormann
A. Patapovas
F. Müller
A. Sonst
H. Glaeser
B. Plank-Kiegele
T. Bürkle
R. Maas
Publikationsdatum: 01.12.2016
DOI: https://doi.org/10.1007/s10049-016-0184-3
Verlag: Springer Medizin
Zeitschrift: Notfall + Rettungsmedizin Zeitschrift für präklinische und innerklinische Notfallmedizin
Ausgabe 8/2016
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578

Springerpflege

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Abstract

Background

Objectives

Methods

Results

Conclusion

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