BackgroundThe thrombin inhibitor dabigatran (D) is the first new oral anticoagulant approved in Europe for the prevention of non-valvular atrial fibrillation; its advantage is that it has less interactions that antagonists of vitamin K.PurposeThe aim of the study was to determine the prevalence and type of potential drug interactions (PDI) in the treatment of patients with D in a health area, and to analyse the possible clinical relevance of these.Material and methodsThe study was performed in a health area serving 194 737 inhabitants for 6 months (July–December 2014). We included all patients treated with D and recorded demographic data and the full treatment prescribed for each patient to identify PDI, which were obtained from programs prescribing and dispensing primary care (ADN and Agoraplus) and managing medication dispensed in hospital (SAVAC). We considered PDI as those described in the technical data and classified according to the mechanism and recommendation indicated. Finally, we estimated the potential clinical relevance of the presence of PDI based on: visits to the emergency department (per patients and average/patient), hospitalisations and diagnoses in emergencies related to an adverse effect to D.ResultsWe included 206 patients treated with D (56% women, mean age 76.8 ± 8.6 years). 128 PDI were recorded in 50.5% of patients, with an average per patient of 1.24 ± 0.53 (75.3% for 1 interaction, 18.6% for 2, 6.2% for >2). 25.8% were pharmacokinetic and 74.2% were pharmacodynamics. In 11 interactions (8.6%), co-administration was contraindicated, in 86 (67.2%) it was necessary to monitor and in 31 (24.2%) the dosage was reduced and track performed. The drug groups involved in the PDI were: 7.8% NSAIDs; 25.8% inhibitors of P-glycoprotein (IGP-P), dronedarone, amiodarone, verapamil, etc; 30.5% antiplatelet drugs; 28,9% SSRI/SNRI; and 7.1% anticoagulants. We did not find significant differences in any of the relevant clinical variables studied between patients with and without PDI.ConclusionA considerable proportion of patients (50.5%) presented PDI in treatment, but without apparent clinical relevance to serious adverse events.The majority of PDI were pharmacodynamic and could be sought to improve the therapeutic effect. However, the significant percentage of PDI with SSRIs suggests that they may be unknown by some prescribers; there is a need to monitor their use along with inhibitors of IGP-P which are often prescribed to these patients.References and/or AcknowledgementsThanks to the documentation department.No conflict of interest.
Fifteen per cent of patients had a change in their treatment before falling. The average number of drugs per patient was nine per day. In these patients, the rate of prescription of drugs at risk of falling was high (87% for hypotensive treatments and 91% for inducing drowsiness treatments). A very high consumption of diuretics (40%) and benzodiazepines (60%) was observed. The combination of benzodiazepines was found in 16% of patients. Respectively, 24% and 65% of patients had a modification in their hypotensive and inducing drowsiness treatments. Conclusion The use of drugs that increased the risk of falling was common in our hospital. The recent change in inducing drowsiness treatments seemed to increase the risk of falling.Pharmaceutical interventions with prescribers on good prescribing practices in the elderly should be strengthened to minimise the use of drugs at risk of falling.
Introducción: la composición lipídica de las fórmulas de nutrición parenteral (NP) se postula como posible factor de evolución clínica.Objetivo: evaluar las diferencias en efi cacia y seguridad de dos emulsiones lipídicas en NP.Material y métodos: estudio clínico prospectivo de pacientes posquirúrgicos sometidos a NP durante más de 7 días en un periodo de 2 años.Se administraron de forma indistinta 2 tipos de emulsiones lipídicas: enriquecida con ácidos grasos omega 3 (SMOFlipid Fresenius Kabi®) o conácido oleico omega 9 (Clinoleic Baxter®). Se analizaron variables epidemiológicas, analíticas, complicaciones infecciosas y mortalidad.Resultados: se estudió un total de 154 pacientes con edad media de 64,36 ± 13,73 años, de los que 95 eran hombres (61%), 78 (51%)recibieron SMOFlipid® y 76 (49%) Clinoleic®. La estancia media fue de 16,91 ± 4,23 días, la duración de la NP 9,68 ± 3,25 días y la mortalidaddel 11%. Se diagnosticaron 58 (37%) infecciones. No existieron diferencias signifi cativas en cuanto a los parámetros analíticos lipídicos,hepáticos o nutricionales (medidos al inicio y al 7.º día) ni en su evolución (estancia media, complicaciones infecciosas ni mortalidad) entre losdos grupos de pacientes.Conclusión: los pacientes sometidos a NP presentan similares características evolutivas con independencia de la emulsión lipídica utilizada.La bibliografía actual apunta a un benefi cio de la disminución del aporte de ácidos grasos omega 9, pero no se han encontrado diferenciassignifi cativas entre las fórmulas comparadas.
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