Impact of computerized dosing on eptifibatide-associated bleeding and mortality.
OBJECTIVE
The study aimed to determine the impact on eptifibatide-associated bleeding by implementing a computerized dosing algorithm in the cardiac catheterization suite.


BACKGROUND
Excessive dosing of eptifibatide is associated with increased bleeding rates and hospital mortality. Although dosing adjustments based on renal function has been recommended, its implementation and clinical impact have not been assessed in daily practice.


METHODS
A computerized algorithm was implemented in January 2006 to calculate appropriate eptifibatide infusion dose (1 microg kg(-1) min(-1) for creatinine clearance <50 mL/min or 2 microg kg(-1) min(-1) for creatinine clearance >or=50 mL/min) using the Cockroft-Gault formula. All patients had hemoglobin measured before and the day after the procedure. Bleeding within 24 hours and mortality during hospitalization were compared in consecutive patients before and after implementation of the algorithm.


RESULTS
A total of 334 patients qualified for inclusion (pre-algorithm n = 91, post-algorithm n = 243). There was an increase in the proportion of patients receiving recommended doses of eptifibatide dosing (74.7% pre-algorithm vs 97.5% post-algorithm, P <or= .0001). Twenty-four-hour bleeding complications as classified using 3 major bleeding classification systems were reduced as was hospital mortality (4.4% vs 0%, P = .005). Packed red blood cell transfusion rates were similar between both groups (4.4% pre-algorithm vs 2.1% post-algorithm, P = .26).


CONCLUSIONS
In patients receiving eptifibatide in the catheterization laboratory before percutaneous coronary intervention, implementation of a computerized algorithm was associated with appropriate dosing and reduced bleeding and mortality.
Putney
David R
DR
Methodist DeBakey Heart and Vascular Center, Houston, TX, USA. dputney@tmhs.org
Kleiman
Neal S
NS
Fromm
Robert E
RE
Buergler
John M
JM
D000465:Algorithms; D054796:Drug Dosage Calculations; D004360:Drug Therapy, Computer-Assisted; D000077542:Eptifibatide; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077542:Eptifibatide