Background HIT is a prothrombotic adverse drug reaction caused by heparin and requires an alternative anticoagulant: danaparoid. Because of its cost and the specific indication, the physicians must request two laboratory tests with prescriptions (LT: Platelet Aggregation Test, Anti PF4H) and a 4Ts assessment, in order to have danaparoid dispensed. Purpose To find out whether prescriptions are justified and if we can use the 4Ts score as a basis for HIT detection. Materials and Methods We analysed 5 years of prescriptions: 4Ts score results (the 4Ts assessment is used to arrive at a high (score 6 or more), intermediate (score 4–5) or low (score 3 or less) probability of HIT. Of 72 hospitalised patients followed (LT and/or prescription), 34 had a LT score without danaparoid prescription (32 negative and 2 positive results). 38 had a prescription that had been dispensed. 32 patients of these 38 had a 4Ts score. Looking at the 4 Ts’ results: 3.12% (1/32) patients had low score (LT not requested). 62.5% (20/32) came into the intermediate category (LT: 8/20 negative – 4/20 positive – uncertain 3/20 – not requested 5/20). 34.4% (11/32) came into the high-score group (LT: 4/11 negative – 4/11 positive – 1/11 uncertain – not requested 2/11). In 60.5% of the cases (23/38), the prescription was justified by a high score or a positive LT test or HIT diagnosed before. In 39.5% of the cases (15/38), a danaparoid prescription wasn’t justified: 7 patients still received danaparoid after negative LT results and 8 without a 4Ts score. Conclusions In our hospital, positive predictive value doesn’t match like it’s written in the literature. The 4Ts score doesn’t seem to favourably correspond with HIT laboratory testing results. A new scoring HIT Expert Probability Score is right now in validation. Will it be more suitable for our practise? No conflict of interest.
BackgroundThe indicatons for rituximab in haematology are classified into 3 categories: group 1: indications for which the medicine was initially marketed (MA), group 2: additional recommendations for temporary use (RTU), and group 3: indications that are not authorised or are lacking sufficient documentation for authorisation by the French Medicines Agency (ANSM), but for which the medicine can be used based on the literature and recommendations. We have a prescription form in which all of the drug’s indications authorised by the ANSM (group 1 and 2) are already written and classified, to encourage safe use of medicines.PurposeTo check if rituximab prescriptions for these indications reflect the actual use of the drug.Material and methodsFor each prescription of rituximab from January to April 2014, we compared the indication on the prescription to the one in the patient’s files (multidisciplinary meetings reports and discharge letters). Every indication was classified by group and we analysed the divergence.ResultsIn our cohort of 52 patients, 80.8% were in prescription group 1, 3.8% in prescription group 2, and 15.4% in prescription group 3. We calculated a 25% divergence between the prescribed indication and the actual one. 16.66% of prescription group 1 and 100% of prescription group 2 indications were in reality group 3 indications. 52.94% of real group 3 prescriptions were not declared as such.ConclusionThis study might question the safety of prefilled prescriptions because doctors might supply incomplete information and pharmacists might therefore approve dispensing of this medicine for incorrect indications. In order to improve safety, we suggest a new kind of prescription form in which all of the medicine’s indications are written without being classified and with more blank spaces to allow the doctor to give additional information about the chemotherapy, the state of the cancer and the number of relapses.References and/or acknowledgementsThanks to my supervisors for their support and advice.No conflict of interest.
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