Drug interactions in a coronary care unit: Adversity or therapeutic success?

Abstract

Objectives

To analyze the prevalence and factors associated with potential clinically significant drug interactions (pDDIs) in a coronary care unit and to describe clinical management for reducing the occurrence of pDDIs.

Methods

A cross-sectional and analytical study was conducted on 120 patients aged ≥ 18 years and who had used two or more medications who were admitted to coronary care unit at a high-complexity hospital in Campinas, São Paulo, Brazil. Participants were recruited consecutively from May 2018 to April 2019. Data were obtained from medical records. The Micromedex tool was used for the analysis of pDDIs. Descriptive statistics and a generalized linear model with Poisson distribution were used to assess the relations between independent variables and exposure to pDDIs.

Results

The prevalence of patients exposed to pDDIs of major severity was 81.6%. 73.8% had the increased risk of bleeding as the clinical impact and involved the co-administration of drugs related to antiplatelet therapy and anticoagulation. Having had a myocardial infarction (P = .007), using a greater number of medications (P = .009), and consuming a greater number of medications that act on the blood and hematopoietic organs (P = .006) increased the likelihood of greater potential drug interactions.

Conclusion

The prevalence of major severity pDDI was high. Having suffered a myocardial infarction, using polypharmacy and receiving medications that act on the blood/hematopoietic organs increased the likelihood of this clinical outcome. However, the most combinations showed synergistic effects that improved cardiocirculatory performance, highlighting the need for therapeutic success, with this contributing to the restoration of patients’ health and improvement in their quality of life.