Drug-induced torsades de pointes in patients aged 80 years or more.
OBJECTIVE
We studied all English-written peer-reviewed reports on drug-induced torsades de pointes (TdP) in patients aged 80 years or more in order to characterize the clinical circumstances leading to this serious complication.


METHODS
Our literature search yielded 24 reports on 25 patients aged 80-95 years with drug-induced TdP. We systematically reviewed each report and recorded the non-modifiable risk factors for drug-induced TdP (i.e., female sex and structural heart disease) as well as preventable clinical circumstances, which might have been associated with drug-induced TdP.


RESULTS
The most prevalent risk factors for drug-induced TdP were non-modifiable risk factors: 22 (88%) patients were female patients and 19 (76%) patients had structural heart disease. Overall, 16 (64%) patients were female patients with structural heart disease. The literature did not report any elderly male patients without structural heart disease. Among the preventable clinical circumstances, which might have been associated with drug-induced TdP, the most prevalent were: administrating QT prolonging agents despite long QT interval (n=11; 44%) and co-administration of two or more QT prolonging agents (n=9; 36%). The most prevalent QT prolonging agents found to trigger TdP were macrolides and quinolones (n=9; 36%). All but three patients had at least one or more preventable clinical circumstances, which might have been associated with drug-induced TdP.


CONCLUSIONS
Physicians should be more aware of the risk for drug-induced TdP in patients aged 80 years or more while administrating QT prolonging agents despite long QT interval and co- administrating two or more QT prolonging agents, specifically in elderly female patients with structural heart disease.
Paran
Yael
Y
Department of Internal Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Mashav
Noa
N
Henis
Oren
O
Swartzon
Michael
M
Arbel
Yaron
Y
Justo
Dan
D
D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced*; D018942:Macrolides / Q000009:adverse effects*; D008297:Male; D015363:Quinolones / Q000009:adverse effects*; D012307:Risk Factors; D012737:Sex Factors; D016171:Torsades de Pointes / Q000139:chemically induced*
D018942:Macrolides; D015363:Quinolones