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Category : Clinical articles, General, Medical Rants

Study of Heart Attacks Finds Risk in Use of Blood Thinners

Patients being treated for heart attacks involving narrowed arteries and clots that reduce blood flow to the heart are often given overdoses of powerful blood-thinning drugs in the emergency room, increasing their risk of serious bleeding, a study has found.

Excessive bleeding occurred at catheter sites, from existing stomach ulcers and in the brain, where it was particularly dangerous, said Dr. Karen Alexander, a researcher at Duke University and the lead author of the study, which is to be published Wednesday in The Journal of the American Medical Association.

Of 30,136 heart patients treated last year at 387 hospitals in the United States, 42 percent were given excessive doses of blood thinners. Those given extra amounts of two blood thinners – low molecular weight heparin and glycoprotein IIb/IIIa blockers, which are sometimes called super-aspirin – had about a 30 percent greater chance of major bleeding than those given the recommended dose.

The study suggests that 15 percent of the bleeding episodes were from overdoses and might have been avoidable.

All medications have risks and benefits. We should always strive to pick the right dose for any medication. While the emergency room can become hectic, each ER should have a method for insuring that patients get the right doses of medications.

Obviously anticoagulants epitomize the danger of overdosing. We know that whenever we prescribe an anticoagulant we increase bleeding risk. Physicians always “calculate” the potential benefit from anticoagulation and compare it with the potential risk.

This article should cause ER physicians to reassess their protocols for anticoagulation in heart attack patients. Or, if they have no protocols, then they should develop clear protocols with their cardiology colleagues.

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Comments (2)

I find it ridiculous that in our current world of technology that medicine is again in the dark ages. I don’t just find this article realistic but likely it under estimates the number of patients who receive inappropriate treatments, tests, etc. while held hostage as inpatients. To think that we have not created feedback loops, automated checks, smart cards or something at individual patient level to maintain a up to date account of their care is simply an embarrassment to our profession. I have sat on these committees evaluating protocols and the fact is that as long as we continue to trust in imperfection of man — i.e. handwritten orders, verbal orders and even nurse driven orders that rarely find themselves into the actual record of the patients care — we will continue to be subjected to mistakes that occur at a clearly shocking rate.

Review of the article text indicates that those facilities with protocols had fewer dosing errors.
And therapy given by a cardiologist was associated with fewer dosing errors.

What seems to be part of the problem is that weight and CrCl are typically not readily known when ordering the medications. The elderly were prone to overdosing – in part to overestimation of CrCl.

So, as the patient is being rushed to have their EKG done within 10 min of arrival, they need to have simultaneous weight and phlebotomy for a chem panel so that accurate calculations for lovenox/UFH or tirofiban can be calculated 🙂

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