Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel
Journal cover image

Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention.

Publication ,  Journal Article
Tsai, TT; Maddox, TM; Roe, MT; Dai, D; Alexander, KP; Ho, PM; Messenger, JC; Nallamothu, BK; Peterson, ED; Rumsfeld, JS ...
Published in: JAMA
December 9, 2009

CONTEXT: The US Food and Drug Administration guides clinicians through drug labeling of medications that are contraindicated or not recommended for use in specific patient groups. Little is known about the use of such medications and their effects on outcomes in clinical practice. OBJECTIVE: To investigate the use of the contraindicated/not-recommended agents enoxaparin and eptifibatide among dialysis patients undergoing percutaneous coronary intervention (PCI) and their association with outcomes. DESIGN, SETTING, AND PARTICIPANTS: Data from 829 US hospitals on 22 778 dialysis patients who underwent PCI between January 1, 2004, and August 31, 2008. MAIN OUTCOME MEASURES: In-hospital bleeding and death. RESULTS: Five thousand eighty-four patients (22.3%) received a contraindicated antithrombotic; of these patients, 2375 (46.7%) received enoxaparin, 3261 (64.1%) received eptifibatide, and 552 (10.9%) received both. Compared with patients who did not receive a contraindicated antithrombotic, patients who did had higher rates of in-hospital bleeding (5.6% vs 2.9%; odds ratio [OR], 1.93; 95% confidence interval [CI],1.66-2.23) and death (6.5% vs 3.9%; OR, 1.68; 95% CI, 1.46-1.95). After multivariable adjustment, patients receiving contraindicated antithrombotics had significantly higher risks of in-hospital bleeding (OR, 1.66; 95% CI, 1.43-1.92) and death (OR, 1.24; 95% CI, 1.04-1.48). In 10 158 patients matched by propensity scores, receipt of contraindicated antithrombotics remained significantly associated with in-hospital bleeding (OR, 1.63; 95% CI, 1.35-1.98) but not in-hospital death (OR, 1.15; 95% CI, 0.97-1.36). CONCLUSIONS: In a sample of dialysis patients undergoing PCI, 22.3% received a contraindicated antithrombotic medication. In propensity-matched analysis, receipt of these medications was significantly associated with an increased risk of in-hospital major bleeding.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

December 9, 2009

Volume

302

Issue

22

Start / End Page

2458 / 2464

Location

United States

Related Subject Headings

  • Risk
  • Renal Dialysis
  • Regression Analysis
  • Registries
  • Propensity Score
  • Peptides
  • Middle Aged
  • Medication Errors
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Tsai, T. T., Maddox, T. M., Roe, M. T., Dai, D., Alexander, K. P., Ho, P. M., … National Cardiovascular Data Registry, . (2009). Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention. JAMA, 302(22), 2458–2464. https://doi.org/10.1001/jama.2009.1800
Tsai, Thomas T., Thomas M. Maddox, Matthew T. Roe, David Dai, Karen P. Alexander, P Michael Ho, John C. Messenger, et al. “Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention.JAMA 302, no. 22 (December 9, 2009): 2458–64. https://doi.org/10.1001/jama.2009.1800.
Tsai TT, Maddox TM, Roe MT, Dai D, Alexander KP, Ho PM, et al. Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention. JAMA. 2009 Dec 9;302(22):2458–64.
Tsai, Thomas T., et al. “Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention.JAMA, vol. 302, no. 22, Dec. 2009, pp. 2458–64. Pubmed, doi:10.1001/jama.2009.1800.
Tsai TT, Maddox TM, Roe MT, Dai D, Alexander KP, Ho PM, Messenger JC, Nallamothu BK, Peterson ED, Rumsfeld JS, National Cardiovascular Data Registry. Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention. JAMA. 2009 Dec 9;302(22):2458–2464.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

December 9, 2009

Volume

302

Issue

22

Start / End Page

2458 / 2464

Location

United States

Related Subject Headings

  • Risk
  • Renal Dialysis
  • Regression Analysis
  • Registries
  • Propensity Score
  • Peptides
  • Middle Aged
  • Medication Errors
  • Male
  • Humans