2 research outputs found
Risk factors for adverse reactions to use of warfarin inpatient: a cohort study
A varfarina é considerada um dos principais fármacos anticoagulantes orais, com o uso clínico a mais de 60 anos, contudo sua utilização ainda remete preocupação quanto aos riscos de suas reações adversas, sendo a hemorragia um dos eventos mais graves. Diante disso, o objetivo deste estudo foi avaliar a incidência das reações adversas decorrente ao uso da varfarina (RAV), em um hospital de alta complexidade, caracterizar o perfil dos pacientes e identificar os principais fatores de risco para as RAV, bem como a conduta diante das ocorrências. Para tal, foi realizado um estudo de coorte prospectivo com o monitoramento durante o período de internação de 309 usuários de varfarina, realizando a identificação das RAV por meio da busca ativa de indicadores, e a avaliação dos fatores de risco e classificação das ocorrências. Dessa forma, encontrou-se a incidência de 12% (n=37) para RAV, com média de idade de 56 anos, não se observando risco superior entre os idosos, ou quanto ao sexo, diferentes etnias, possuir hábitos tabágicos e etilismo. Em relação as ocorrências 51,4% dos pacientes apresentaram RAV grave, enquanto para 21,6% a RAV foi responsável de forma direta ou indiretamente pela morte do paciente. Observou-se média 25,8 fármacos entre os pacientes com RAV em comparação a 13,4 para os pacientes que não apresentaram a ocorrência, 24,3% dos pacientes com RAV foram admitidos no centro de terapia intensiva (CTI), e 75,7% apresentaram tempo de internação superior a 15 dias. Entre os fatores de risco observados, destacou-se a piora da função renal (RR 12,85. IC95% 5,19; 31,77), redução da albumina (RR 2,24. IC95% 1,64; 3,06), o elevado número de medicamentos (RR 3,36. IC95% 1,66; 6,78), e de interações medicamentosas com risco superior para os fármacos dipirona, lactulose, quetiapina, ranitidina e polivitamicos. A prescrição de concentrado de hemácias (51,4%), plasma fresco (48,7%) e vitamina K (43,2%) foram as condutas mais frequentes na reversão e manejo das RAV. Em conclusão as RAV apresentaram elevada gravidade entre os pacientes, com altas taxas de transfusões, ampliação no tempo de internação, no número de medicamentos utilizados e na frequência de admissões no CTI.Warfarin is one of the main oral anticoagulant drugs in use for more than 60 years. However, its use still raises concerns about the risks of its adverse reactions, and hemorrhage is one of the most serious events. Therefore, the objective of this study was to evaluate the incidence of adverse reactions due to the use of warfarin (RAV) in a high complexity hospital, to characterize the patients\' profile and to identify the main risk factors for RAV, as well as the conduct in the face of occurrences. A prospective cohort study was carried out with the monitoring during the hospitalization period of 309 warfarin users, performing the identification and classification of the RAV through an active search of indicators, and the evaluation of risk factors of them. Thus, the incidence of 12% (n = 37) was found for RAV, with a mean age of 56 years, with no higher risk among the elderly, or with regard to gender, different ethnicities, smoking habits, and alcoholism. Regarding the occurrences, 51.4% of the patients presented severe RAV, whereas for 21.6% the RAV was directly or indirectly responsible for the death of the patient. We observed a mean of 25.8 drugs among patients with RAV compared to 13.4 for patients who did not present this event, 24.3% of patients with RAV were admitted to the intensive care unit (ICU), and 75.7% had hospitalization time of more than 15 days. Among the risk factors observed highlights renal function worsened (RR 12.85, IC95% 5.19; 31.77), albumin reduction (RR 2.24, IC95% 1.64; 3.06), the high number of medications (RR 3.36, IC95% 1.66; 6.78) and drug interactions for the metamizole, lactulose, quetiapine, ranitidine and poly vitamin drugs. The prescription of packed red blood cells (51.4%), fresh plasma (48.7%) and vitamin K (43.2%) were the most frequent behaviors in the reversion and management of RAV. In conclusion, the RAV presented high severity among the patients, with high transfusion rates, the increase in the length of hospital stay, number of used medications, and admission frequency in ICU
Analysis of clinical pharmacist interventions in the neurology unit of a Brazilian tertiary teaching hospital.
It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student's t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was "untreated condition". From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to "drug introduction" (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy