title: Use of Contraindicated Antiplatelet Medications in the Setting of Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
abstract: Several antiplatelet medications used during and after percutaneous coronary intervention (PCI) are contraindicated for specific patient groups. A broad assessment of contraindicated medication use and associated clinical outcomes is not well described.
  
  
  
  Using national Veterans Affairs Clinical Assessment, Reporting, and Tracking Program data for all PCI between 2007 and 2013, we evaluated patients with contraindications to commonly used antiplatelet medications during and after PCI, defined in accordance with package inserts. Adjusted association between contraindicated medication use and outcomes of periprocedural bleeding and 30-day mortality were assessed using Cox proportional hazards with inverse probability weighting. Among 64 294 patients undergoing PCI, 11 315(17.6%) had a contraindication to a common antiplatelet medication and 737 (6.5%) of these patients received a contraindicated medication. In unadjusted analyses, any contraindicated medication use was associated with both increased bleeding and 30-day mortality. In adjusted models, contraindicated abciximab use in patients with thrombocytopenia (hazard ratio, 2.23; 95% confidence interval, 1.58-3.16) and in patients with a previous stroke (hazard ratio, 1.93; 95% confidence interval, 1.37-2.71) remained significantly associated with increased bleeding. Contraindicated abciximab use was not significantly associated with 30-day mortality in adjusted models. Use of eptifibatide in dialysis patients was not significantly associated with an increased risk of bleeding or mortality.
  
  
  
  In this national cohort, ≈18% of patients undergoing PCI had contraindications to common antiplatelet medications. Approximately 6% of those patients received a contraindicated medication with attendant bleeding risk, although this did not translate into significantly higher risk of 30-day mortality. Continued efforts to reduce contraindicated medication use may help avoid periprocedural complications.
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.). gbarnes@umich.edu.
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Barnes
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Maggie A
authors.initials: MA
authors.lastname: Stanislawski
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Wenhui
authors.initials: W
authors.lastname: Liu
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Anna E
authors.initials: AE
authors.lastname: Barón
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Andrew
authors.initials: A
authors.lastname: Klein
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: From the University of Michigan Frankel Cardiovascular Center, Ann Arbor VA Medical Center, MI (G.D.B., B.K.N.); Denver VA Medical Center, CO (M.A.S., W.L., E.J.A., P.M.H., T.M.M., J.S.R., S.M.B.); School of Public Health, University of Colorado at Denver (A.E.B.); St. Louis VA Medical Center, MO (A.K.); and Institute for Heath Research, Kaiser Permanente Colorado, Denver (T.T.T.).
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
mesh_terms: D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal; D016009:Chi-Square Distribution; D000075202:Contraindications; D016208:Databases, Factual; D004348:Drug Labeling; D017723:Drug Utilization Review; D000077542:Eptifibatide; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D061214:Patient Safety; D018579:Patient Selection; D010455:Peptides; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077542:Eptifibatide; D000077284:Abciximab
keywords: abciximab; eptifibatide; medication errors; mortality; percutaneous coronary intervention