More than 40% patients with non-ST-segment elevation acute coronary syndromes were given the wrong dose of antiplatelet or antithrombin medications, according to results of a large observational study.
Most of the errors involved doses above the recommended range, reported Karen Alexander, M.D., of the Duke Clinical Research Institute, and colleagues, in the Dec. 28 issue of the Journal of the American Medical Association.
The drugs were unfractionated heparin, low-molecular weight heparin, and glycoprotein IIb/IIIa inhibitors, wrote Dr. Alexander and colleagues.
In the prospective observational analysis in 387 U.S. academic and non-academic hospitals, 42% of patients had at least one initial dose outside recommended ranges. Moreover, excess dosing errors were more likely in vulnerable subgroups, including women, the elderly, and those with renal insufficiency, Dr. Alexander and colleagues found.
These were patients already at increased risk for bleeding. Such patients were in "double jeopardy" for bleeding complications, the researchers wrote.
The study goes on to say that almost 1/3rd of patients on heparin, and over 1/4 of patients on glycoprotein IIb/IIIa inhibitors were on too much. Of note, the low molecular weight heparins were overdosed about 13% of the time, implying a greater margin of safety compared to traditional heparin.
The full study is in today's JAMA.
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