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General and Risk Management, Patient Safety (including: medication errors, quality control)
Excess dosing and bleeding events in patients treated with abciximab in acute coronary syndromes
  1. A. de Lorenzo-Pinto,
  2. B. Cuéllar-Basterrechea,
  3. H. Bueno-Zamora,
  4. J. Elízaga-Corrales,
  5. A. de Prado,
  6. A. Herranz-Alonso,
  7. C.G. Rodríguez-González,
  8. C. Pérez-Sanz,
  9. M. Sanjurjo-Sáez
  1. 1Hospital General Universitario Gregorio Marañon, Pharmacy, Madrid, Spain
  2. 2Hospital General Universitario Gregorio Marañon, Cardiology, Madrid, Spain

Abstract

Background Abciximab (ABX) is indicated as an adjunctive to percutaneous coronary intervention in patients with acute coronary syndrome (ACS). It is considered a high-alert medicine with heightened risk of causing significant patient harm when used in error. Evidence-based guidelines recommend an intravenous administration of a 0.25 mg/kg bolus dose followed by continuous infusion of a weight-adjusted infusion of 0.125 mcg/kg/min (<80 kg) to a maximum of 10 mcg/min for 12 h (≥80 Kg).

Purpose The purpose of this study was to investigate dosing of ABX and its association with bleeding events in patients with ACS.

Materials and methods A retrospective chart review was performed in all patients hospitalised between January and July 2010 at our hospital. Inclusion criteria were: patients >18 years of age, diagnosed with ACS and treated with ABX during their hospitalisation. A database was designed to record patient demographics (age, sex) weight, loading dose, maintenance dose, duration of prescribed ABX and bleeding events.

Results 73 patients diagnosed with ACS were treated with ABX. Median age was 65 (55–73) years old and 78.1% were male. 24.7% of patients were not weighed before ABX administration. All patients who received ABX infusion were treated with a fixed, body weight-independent, dose of 10 mcg/min infused for 12 h (maximum dose) meaning that 28.8% of patients received an overdose of ABX. 66.7% of them developed a bleeding event compared with 32.8% of patients receiving the correct dose (p=0.016).

Conclusions Overdose of ABX seems to be associated with high risk of developing bleeding events in patients with ACS. Some new procedures have been brought in such as hoists with weighing scales and a table made available containing the appropriate dose and infusion rate for each weight. These facilities could be perfectly applicable to other hospitals. Further analysis should be carried out to determine the effect of other potential risk factors.

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