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Observational Study
. 2024 Jan;90(1):164-175.
doi: 10.1111/bcp.15882. Epub 2023 Sep 4.

Adverse drug events caused by three high-risk drug-drug interactions in patients admitted to intensive care units: A multicentre retrospective observational study

Joanna E Klopotowska  1   2 , Jan-Hendrik Leopold  1   2 , Tinka Bakker  1   2 , Izak Yasrebi-de Kom  1   2 , Frouke M Engelaer  3 , Evert de Jonge  3 , Esther K Haspels-Hogervorst  4 , Walter M van den Bergh  4 , Maurits H Renes  4 , Bas T de Jong  5 , Hans Kieft  5 , Andre Wieringa  6 , Stefaan Hendriks  7 , Cedric Lau  8 , Sjoerd H W van Bree  9 , Hendrick J W Lammers  10 , Peter C Wierenga  10 , Rob J Bosman  11 , Vincent M de Jong  11 , Mirjam Slijkhuis  12 , Eric J F Franssen  12 , Wytze J Vermeijden  13 , Joost Masselink  14 , Ilse M Purmer  15 , Liesbeth E Bosma  16 , Martin Hoeksema  17 , Elsbeth Wesselink  18 , Dylan W de Lange  19 , Nicolette F de Keizer  1   2 , Dave A Dongelmans  20   21 , Ameen Abu-Hanna  1   2
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Free article
Observational Study

Adverse drug events caused by three high-risk drug-drug interactions in patients admitted to intensive care units: A multicentre retrospective observational study

Joanna E Klopotowska et al. Br J Clin Pharmacol. 2024 Jan.
Free article

Abstract

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.

Keywords: adverse drug events; drug-drug interactions; intensive care; patient safety; triggers.

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References

REFERENCES

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