Common drugs cause most ADE hospitalizations among older patients

【老年人药物不良事件多源于常用药物】根据美国疾病预防控制中心（CDC）药物治疗安全项目主管Daniel S. Budnitz博士及其同事在11月24日的《新英格兰医学杂志》上发表的一项研究，每年有接近100,000名年龄超过65岁的美国老年人因药物不良反应入院，66%为意外用药过量所致。这些急症多数是由几类常用药物引起的，涉及最多的药物为华法林、胰岛素、口服抗血小板药物及口服降糖药。

Common drugs cause most ADE hospitalizations among older patients

Warfarin, insulin, antiplatelets, and hypoglycemic drugs implicated in more than 60 times as many adverse event hospitalizations as high-risk medications.

Of the nearly 100,000 emergency hospitalizations due to adverse drug events (ADEs) in patients 65 years and older, 67.0% were linked to four common medications or medication classes, while high-risk medications were implicated in only 1.2% of these cases, according to a study conducted by Daniel Budnitz, MD, MPH, Director of the CDC Medication Safety Program, and colleagues and published in the New England Journal of Medicine.

Using adverse event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance Project from 2007 to 2009, Budnitz and colleagues estimated that there were 99,628 (95% CI 55,531–143,724) hospitalizations each year for adverse drug events resulting from emergency department visits in patients at least 65 years old.

The majority of ADE hospitalizations (67.0% [95% CI 60.0%–74.1%]) implicated warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%). High-risk medications, as defined by the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set, were implicated in far fewer cases (1.2% [0.7%–1.7%]), Budnitz and colleagues found. Five therapeutic categories accounted for 88.3% (84.7%–91.9%) of ADE hospitalizations: hematologic, endocrine, cardiovascular, central nervous system, and anti-infective agents.

Of the more than 99,000 annual ADE hospitalizations, 48.1% (44.6%–51.6%) were in patients 80 years and older and 65.7% (60.1%–71.3%) were due to unintentional overdoses. Visits resulting in hospitalization were more likely to involve unintentional overdoses and five or more concomitant medications than those that didn’t result in hospitalization, the researchers found.

“Coordinated efforts to promote the safe management of antithrombotic and antidiabetic agents have the potential to substantially reduce harm to patients,” Budnitz and colleagues wrote. These ADEs are a “substantial burden” for patients and for the health care system, they wrote, noting, “With an estimated 21,010 hospitalizations for warfarin-related hemorrhages, the cost for this one type of adverse drug event is probably hundred of millions of dollars annually.”

Budnitz and colleagues concluded that “efforts to improve medication safety for older adults should focus on areas in which improvements are most likely to have sizable, clinically significant, and measurable effects, such as improving the management of antithrombotic and antidiabetic drugs.”


链接：http://www.pharmacist.com/AM/Tem ... /CM/HTMLDisplay.cfm