PDF(Pubmed)
Abstract：
Background: An international consensus list of potentially clinically significant drug-drug interactions (DDIs) in older people has been recently validated. Our objective was to describe the prevalence and characteristics of drug combinations potentially causing clinically significant DDIs identified in the medication history of older patients admitted to the hospital and the prevalence and characteristics of manifest DDIs-DDIs involved in adverse drug events present at hospital admission, DDIs that contributed to ADE-related hospital admissions, and DDIs involved in drug-related laboratory deviations. Methods: The data were obtained from our previous study that examined the drug-relatedness of hospital admissions to University Hospital Hradec Králové via the department of emergency medicine in the Czech Republic. Patients ≥ 65 years old were included. Drug combinations potentially causing clinically significant DDIs were identified using the international consensus list of potentially clinically significant DDIs in older people. Results: Of the 812 older patients admitted to the hospital, 46% were exposed to drug combinations potentially causing clinically significant DDIs. A combination of medications that affect potassium concentrations accounted for 47% of all drug combinations potentially causing clinically significant DDIs. In 27 cases, potentially clinically significant DDIs were associated with drug-related hospital admissions. In 4 cases, potentially clinically significant DDIs were associated with ADEs that were present at admissions. In 4 cases, the potentially clinically significant DDIs were associated with laboratory deviations. Manifest DDIs that contributed to drug-related hospital admissions most frequently involved antithrombotic agents and central nervous system depressants. Conclusion: The results confirm the findings from the European OPERAM trial, which found that drug combinations potentially causing clinically significant DDIs are very common in older patients. Manifest DDIs were present in 4.3% of older patients admitted to the hospital. In 3.3%, manifest DDIs contributed to drug-related hospital admissions. The difference in the rates of potential and manifest DDIs suggests that if a computerized decision support system is used for alerting potentially clinically significant DDIs in older patients, it needs to be contextualized (e.g., take concomitant medications, doses of medications, laboratory values, and patients\' comorbidities into account).
摘要：
背景：最近已经验证了在老年人中潜在具有临床意义的药物-药物相互作用（DDI）的国际共识清单。我们的目标是描述在住院的老年患者的用药史中发现的可能导致临床上显著DDI的药物组合的患病率和特征，以及在入院时出现的不良药物事件中明显的DDI-DDI的患病率和特征。DDI有助于ADE相关的医院入院，和DDI涉及药物相关实验室偏差。方法：数据来自我们先前的研究，该研究通过捷克共和国的急诊医学部检查了赫拉德茨·克拉洛韦大学医院入院的药物相关性。包括≥65岁的患者。使用老年人中潜在临床显著DDI的国际共识列表鉴定了可能引起临床显著DDI的药物组合。结果：在医院收治的812名老年患者中，46%的人暴露于可能导致临床显著DDI的药物组合。影响钾浓度的药物组合占所有可能导致临床显著DDI的药物组合的47%。在27个案例中，有潜在临床意义的DDI与药物相关的住院相关.在4个案例中，有潜在临床意义的DDI与入院时存在的ADE相关.在4个案例中，潜在临床意义的DDI与实验室偏差相关.导致药物相关住院的明显DDI最常见的是抗血栓药物和中枢神经系统抑制剂。结论：结果证实了欧洲OPERAM试验的结果，研究发现，可能引起临床显著DDI的药物组合在老年患者中非常常见。入院的老年患者中有4.3％存在明显的DDI。在3.3%中，明显的DDI促成了与药物相关的住院。潜在DDI和明显DDI比率的差异表明，如果使用计算机化决策支持系统来警告老年患者中潜在的临床重大DDI，它需要上下文化(例如，服用合并药物，剂量的药物，实验室值，并考虑患者的合并症)。
