TY - JOUR
T1 - Adverse drug events caused by three high-risk drug–drug interactions in patients admitted to intensive care units
T2 - A multicentre retrospective observational study
AU - Klopotowska, Joanna E.
AU - Leopold, Jan Hendrik
AU - Bakker, Tinka
AU - Yasrebi-de Kom, Izak
AU - Engelaer, Frouke M.
AU - de Jonge, Evert
AU - Haspels-Hogervorst, Esther K.
AU - van den Bergh, Walter M.
AU - Renes, Maurits H.
AU - Jong, Bas T.
AU - Kieft, Hans
AU - Wieringa, Andre
AU - Hendriks, Stefaan
AU - Lau, Cedric
AU - van Bree, Sjoerd H.W.
AU - Lammers, Hendrick J.W.
AU - Wierenga, Peter C.
AU - Bosman, Rob J.
AU - de Jong, Vincent M.
AU - Slijkhuis, Mirjam
AU - Franssen, Eric J.F.
AU - Vermeijden, Wytze J.
AU - Masselink, Joost
AU - Purmer, Ilse M.
AU - Bosma, Liesbeth E.
AU - Hoeksema, Martin
AU - Wesselink, Elsbeth
AU - de Lange, Dylan W.
AU - de Keizer, Nicolette F.
AU - Dongelmans, Dave A.
AU - Abu-Hanna, Ameen
N1 - Publisher Copyright:
© 2023 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
PY - 2024/1
Y1 - 2024/1
N2 - Aims: Knowledge about adverse drug events caused by drug–drug interactions (DDI-ADEs) is limited. We aimed to provide detailed insights about DDI-ADEs related to three frequent, high-risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. Methods: We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e-triggers) to preselect patients with potential DDI-ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI-ADEs using internationally prevailing standards. Results: In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e-triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI-ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI-INR+ e-trigger (0.76), followed by DDI-AKI e-trigger (0.57). Conclusion: The highly preventable nature and severity of DDI-ADEs, calls for action to optimize ICU patient safety. Use of e-triggers proved to be a promising preselection strategy.
AB - Aims: Knowledge about adverse drug events caused by drug–drug interactions (DDI-ADEs) is limited. We aimed to provide detailed insights about DDI-ADEs related to three frequent, high-risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. Methods: We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e-triggers) to preselect patients with potential DDI-ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI-ADEs using internationally prevailing standards. Results: In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e-triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI-ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI-INR+ e-trigger (0.76), followed by DDI-AKI e-trigger (0.57). Conclusion: The highly preventable nature and severity of DDI-ADEs, calls for action to optimize ICU patient safety. Use of e-triggers proved to be a promising preselection strategy.
KW - adverse drug events
KW - drug–drug interactions
KW - intensive care
KW - patient safety
KW - triggers
UR - http://www.scopus.com/inward/record.url?scp=85169689287&partnerID=8YFLogxK
U2 - 10.1111/bcp.15882
DO - 10.1111/bcp.15882
M3 - Article
C2 - 37567767
AN - SCOPUS:85169689287
SN - 0306-5251
VL - 90
SP - 164
EP - 175
JO - British Journal of Clinical Pharmacology
JF - British Journal of Clinical Pharmacology
IS - 1
ER -