Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism.

Détails

ID Serval
serval:BIB_32DD3EC7D47E
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism.
Périodique
Journal of General Internal Medicine
Auteur(s)
Leiss W., Méan M., Limacher A., Righini M., Jaeger K., Beer H.J., Osterwalder J., Frauchiger B., Matter C.M., Kucher N., Angelillo-Scherrer A., Cornuz J., Banyai M., Lämmle B., Husmann M., Egloff M., Aschwanden M., Rodondi N., Aujesky D.
ISSN
1525-1497 (Electronic)
ISSN-L
0884-8734
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
30
Numéro
1
Pages
17-24
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish
Résumé
BACKGROUND: Polypharmacy, defined as the concomitant use of multiple medications, is very common in the elderly and may trigger drug-drug interactions and increase the risk of falls in patients receiving vitamin K antagonists.
OBJECTIVE: To examine whether polypharmacy increases the risk of bleeding in elderly patients who receive vitamin K antagonists for acute venous thromboembolism (VTE).
DESIGN: We used a prospective cohort study.
PARTICIPANTS: In a multicenter Swiss cohort, we studied 830 patients aged ≥ 65 years with VTE.
MAIN MEASURES: We defined polypharmacy as the prescription of more than four different drugs. We assessed the association between polypharmacy and the time to a first major and clinically relevant non-major bleeding, accounting for the competing risk of death. We adjusted for known bleeding risk factors (age, gender, pulmonary embolism, active cancer, arterial hypertension, cardiac disease, cerebrovascular disease, chronic liver and renal disease, diabetes mellitus, history of major bleeding, recent surgery, anemia, thrombocytopenia) and periods of vitamin K antagonist treatment as a time-varying covariate.
KEY RESULTS: Overall, 413 (49.8 %) patients had polypharmacy. The mean follow-up duration was 17.8 months. Patients with polypharmacy had a significantly higher incidence of major (9.0 vs. 4.1 events/100 patient-years; incidence rate ratio [IRR] 2.18, 95 % confidence interval [CI] 1.32-3.68) and clinically relevant non-major bleeding (14.8 vs. 8.0 events/100 patient-years; IRR 1.85, 95 % CI 1.27-2.71) than patients without polypharmacy. After adjustment, polypharmacy was significantly associated with major (sub-hazard ratio [SHR] 1.83, 95 % CI 1.03-3.25) and clinically relevant non-major bleeding (SHR 1.60, 95 % CI 1.06-2.42).
CONCLUSIONS: Polypharmacy is associated with an increased risk of both major and clinically relevant non-major bleeding in elderly patients receiving vitamin K antagonists for VTE.
Pubmed
Web of science
Création de la notice
07/02/2015 13:56
Dernière modification de la notice
16/10/2019 16:17
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