Philip Grgurich, BCCCP,
Professor of Pharmacy Practice
Massachusetts College of Pharmacy, Massachusetts
Disclosure information not submitted.
Lily Vitali, PharmD
PGY2 Ambulatory Care Pharmacy Resident
Lahey Hospital & Medical Center, United States
Disclosure information not submitted.
Tara Lech, PharmD, BCPS
Thrombosis Program Manager
Lahey Hospital & Medical Center, United States
Disclosure information not submitted.
Leah Mangini, PharmD, BCPS
Clinical Pharmacist
Lahey Hospital, United States
Disclosure information not submitted.
Title: Evaluation of medication-related risk factors for major bleeding in critically ill patients
Introduction: Over half of intensive care unit (ICU) admissions related to an adverse drug event (ADE) are preventable, and bleeding is the most common ADE-related admission diagnosis. Several medication classes, including antiplatelets, anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, serotonergic antidepressants and some herbal products, increase the risk for major bleeding. We evaluated the rate of prior to admission (PTA) use of medications that predispose to bleeding in patients admitted to an ICU at our institution for major bleeding.
Methods: This is an IRB-approved, retrospective, single-center study of patients 18 years and older who had a pharmacy-obtained home medication list and were admitted to a medical or surgical ICU for major bleeding between January 2019 to December 2019. Patients were excluded if bleeding was attributed to trauma, post-surgical complications, or drug overdose. Data collected from the electronic health record included baseline characteristics, PTA medications, and bleeding outcomes. Descriptive statistics were used to characterize the study population and risk factors for bleeding.
Results: 75 patients were included. The median age was 70 (IQR, 55.0-79.5), 45.3% were female, and 75% had hypertension. Of the 55 (73.3%) patients on a medication PTA that may increase bleeding risk, 28 (37.3%) were on antiplatelets, 21 (28.0%) were on anticoagulants, 18 (24.0%) were on serotonergic antidepressants, 11 (14.7%) were on herbal supplements known to cause bleeding, 5 (6.7%) were on NSAIDs, and 2 (2.7%) were on corticosteroids. Most patients experienced intracranial bleeding (54.7%), followed by gastrointestinal (GI) bleeding (42.7%), then retroperitoneal and genitourinary bleeding (2.6%). 28 (37.3%) were on more than one PTA medication that may predispose to bleeding. More patients with GI bleeding were taking a predisposing PTA medication (84.4%) as compared to the patients with intracranial bleeding (63.4%).
Conclusions: PTA medications were involved in 73% of these ICU admissions for major bleeding, with 37% of patients being on more than one predisposing PTA medication. For patients on medications that predispose to bleeding, it is important to consider other risk factors for bleeding, the medication indication, and appropriate duration of therapy.