Contraindicated Medications in the Setting of PCI

Study Questions:

What is the use of contraindicated medications in the setting of percutaneous coronary intervention (PCI), and what is the risk-adjusted association between contraindicated use of the procedural medications and outcomes of periprocedural bleeding and all-cause mortality?

Methods:

This was a retrospective analysis of data from the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) Program data. The authors estimated use of the following antiplatelet medications used in the setting of PCI: prasugrel, ticagrelor, abciximab, eptifibatide, or tirofiban. Medication contraindications were defined in accordance with package inserts between October 1, 2007, and September 30, 2013. All-cause mortality was determined through the VA vital status file. Periprocedural bleeding events were defined as occurring within 3 days of PCI.

Results:

Of the 64,294 patients who underwent PCI, 11,315 (17.6%) had a condition that would make at least one antiplatelet agent’s use contraindicated. Among patients with a contraindication to at least one antiplatelet medication, 737 (6.5%; 1.1% of total PCI population) patients received a contraindicated medication in the periprocedural setting or at hospital discharge. In adjusted models, contraindicated abciximab use in patients with thrombocytopenia (hazard ratio, 2.23; 95% confidence interval, 1.58-3.16) and in patients with a previous stroke (hazard ratio, 1.93; 95% confidence interval, 1.37-2.71) remained significantly associated with increased bleeding. However, contraindicated abciximab use was not significantly associated with 30-day mortality in adjusted models.

Conclusions:

In a national VA cohort, about 18% of patients undergoing PCI had contraindications to common antiplatelet medications, and 6% of these patients received contraindicated medications.

Perspective:

This is an important study that corroborates the extent of contraindicated medication use practice in the PCI setting. While the use of contraindicated medications only involved about 1% of the total PCI population, the authors correctly emphasize the need for “efforts to curb the use of contraindicated antiplatelet medications in the cardiac catheterization laboratory.”

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Prevention, Interventions and ACS

Keywords: Acute Coronary Syndrome, Cardiac Catheterization, Drug Labeling, Hemorrhage, Medication Errors, Mortality, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Risk Assessment, Secondary Prevention, Stroke, Thrombocytopenia, Veterans


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