Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Misdosing common for powerful anti-clotting drugs

29.12.2005


Because of inaccuracies in prescribing, 42 percent of patients rushed to emergency rooms with symptoms of a heart attack received doses of powerful drugs intended stop clotting in coronary arteries outside of the recommended range, a new analysis by Duke Clinical Research Institute (DCRI) cardiologists has found.



While numerous clinical trials have proven that these drugs can save lives, correct dosing is crucial, the researchers said, since the therapeutic window is narrow. Too much of the drug can lead to bleeding episodes, while too little may be ineffective at stopping the clotting process.

The Duke researchers believe that when evaluating these patients in emergency rooms, physicians should spend a little more time clarifying information – such as weight and kidney function – which are necessary for accurate dosing. The researchers also hope that the results of their analysis provide concrete steps to improve safety thereby increasing physician confidence in using these drugs on high risk patients, who have the most to gain.


"These drugs are clearly beneficial, and when dosed correctly, are also safe," said Duke cardiologist Karen Alexander, M.D., lead investigator of the study published Dec. 28, 2005, in the Journal of the American Medical Association.

The drugs in question – unfractionated heparin (UFH), low-molecular-weight heparin (LMWH) and glycoprotein IIb/IIIa inhibitors – work by either preventing the aggregation of platelets in coronary arteries or interfering with the formation of blood clots. The drugs are typically given within the first 24 hours of heart attack symptoms, and it is not uncommon for patients to receive combinations of these drugs during their hospital stay. Doses are determined by patient-specific data incorporated into standard prescribing algorithms.

"Our analysis, which includes patients treated in all types of hospitals across the country shows that dosing errors occur more often in vulnerable patients, such as women, the elderly, or those with kidney insufficiency or low body weight," she said.

Bleeding episodes typically involve oozing at site of catheterization insertion in the leg, but can also include more dangerous bleeding within the gastrointestinal tract or even within the brain. Also, research conducted at Duke and elsewhere has demonstrated that the transfusion of donated blood to replace blood loss is not as benign as once thought. (will link to Rao study)

For the analysis, Alexander drew on the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology and American Heart Association) database. This effort is a national quality improvement initiative which collects data from more than 400 hospitals nationwide and reports back to each hospital every three months on their adherence to the guidelines.

The researchers identified 30,136 patients treated during a nine-month period in 2004 at 387 U.S. hospitals for symptoms of a possible heart attack. These symptoms include chest pain (unstable angina), irregular readings on an electrocardiograph or elevated chemical markers of cell death.

The team’s analysis of the records revealed that 42 percent of the patients in the sample received doses of the anti-clotting drugs outside of the recommended range. They found that those patients who had excess doses had increased risks of bleeding. The researchers also found that mortality and length of hospital stay were higher in patients who received excess doses. From their analysis, the researchers believe that approximately 15 percent of all major bleeding episodes in this group of patients can be attributed to excess dosing.

"This is one of the first studies to look at dosing issues in a real-world population" Alexander said, pointing out that only about 2 percent of patients in the CRUSADE database participate in clinical trials, where use of these drugs under study is usually tightly controlled and regimented.

"The patients in our study who received the recommended doses of heparins or glycoprotein IIb/IIIa inhibitors alone or in combination had the lowest rates of bleeding," Alexander said. "This suggests that the safety demonstrated in the clinical trials may be attainable in community settings with improved dosing accuracy."

She added that since more than 1 million Americans with the symptoms documented by CRUSADE are admitted to the hospital each year, efforts to improve the accuracy of dosing could have significant health and cost benefits.

Richard Merritt | EurekAlert!
Further information:
http://www.mc.duke.edu

More articles from Health and Medicine:

nachricht A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital

nachricht Stem cell transplants: activating signal paths may protect from graft-versus-host disease
20.04.2017 | Technische Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

DGIST develops 20 times faster biosensor

24.04.2017 | Physics and Astronomy

Nanoimprinted hyperlens array: Paving the way for practical super-resolution imaging

24.04.2017 | Materials Sciences

Atomic-level motion may drive bacteria's ability to evade immune system defenses

24.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>