News & Commentary

Antiplatelet Misuse Down, Not Gone


Perfection is unreachable but that shouldn’t stop the health care system for reaching anyway. Take the issue of patients undergoing percutaneous coronary intervention (PCI). When patients have certain conditions (e.g., end-stage renal disease or a recent stroke), they should not get certain contraindicated antiplatelet medications. For the most part, doctors hold the line, according to a study in Circulation: Cardiovascular Quality and Outcomes.

Only 1.1% of 64,294 patients who had PCI performed from 2007 to 2013 received contraindicated antiplatelet medication. The data were taken from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

About 18% of patients undergoing PCI had contraindications to common antiplatelet medications, the study stated, and roughly 6% of those patients received contraindicated medication that could have caused bleeding. Fortunately, though, the contraindicated medications did not result in a significantly higher risk of 30-day mortality.

The contraindicated drugs that were used the most often were eptifibatide (Integrilin) (13.7%) and abciximab (Reopro) (4.6%). One of the problems, say the University of Michigan researchers who conducted the study, is that PCIs “are often performed urgently or emergently … antiplatelet medications are often administered before they are entered into the medical chart in response to verbal orders given during the procedure, potentially limiting the ability for an EMR-triggered alert to prevent the use in patients with a known contraindication.”

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