Abstract | 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: 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.
|
Authors | Waltraud Leiss, Marie Méan, Andreas Limacher, Marc Righini, Kurt Jaeger, Hans-Jürg Beer, Joseph Osterwalder, Beat Frauchiger, Christian M Matter, Nils Kucher, Anne Angelillo-Scherrer, Jacques Cornuz, Martin Banyai, Bernhard Lämmle, Marc Husmann, Michael Egloff, Markus Aschwanden, Nicolas Rodondi, Drahomir Aujesky |
Journal | Journal of general internal medicine
(J Gen Intern Med)
Vol. 30
Issue 1
Pg. 17-24
(Jan 2015)
ISSN: 1525-1497 [Electronic] United States |
PMID | 25143224
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
|
Chemical References |
|
Topics |
- Aged
- Aged, 80 and over
- Anticoagulants
(adverse effects, therapeutic use)
- Female
- Hemorrhage
(chemically induced, epidemiology)
- Humans
- Kaplan-Meier Estimate
- Male
- Polypharmacy
- Prospective Studies
- Risk Factors
- Switzerland
(epidemiology)
- Venous Thromboembolism
(drug therapy, epidemiology)
- Vitamin K
(antagonists & inhibitors)
|
|
Join CureHunter, for free Research Interface BASIC access!
Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease.
Find out why thousands of doctors, pharma researchers and patient activists
around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!
|