Skip to main content

Advertisement

SpringerLink
Log in

The appropriateness of antiplatelet and anticoagulant drug prescriptions in hospitalized patients in an internal medicine ward

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Polypharmacy increases the risk of potentially inappropriate prescribing. STOPP&START criteria identify a group of drugs representing inappropriate medication and a group of drugs representing potential prescribing omissions.

Aims

To evaluate the appropriateness of prescription of antiplatelet and anticoagulant drugs in a sample of patients admitted to an internal medicine ward and their impact on three different outcomes: length of hospitalization, intra-hospital death, and risk of re-admission in the hospital.

Methods

We analyzed a cohort of 485 inpatients followed for 1 year after discharge from the hospital.

Results

The study sample had a mean age of 70.4 ± 17.6 years, and 48.9% were female. Clinical indication for antiplatelet was not appropriate in 41.2% of the subjects. Anticoagulant therapy was not appropriate in 22.8% of the subjects: there was incorrect clinical indication in 5/33 and inappropriate dosing in 28/33. START criteria for antiplatelet drug, but neither STOPP criteria for antiplatelet nor for anticoagulant was positively associated with the length of hospitalization (t = 3.08, p < 0.01). START criteria for anticoagulant medication were associated with greater odds of intra-hospital mortality (OR 5.16, 95% CI 1.92–13.85, p < 0.0001) and with lower odds of re-admission to the hospital within 12 months (OR 0.38, 95% CI 0.18–0.80, p < 0.01).

Discussion

The non-prescription of antiplatelet is associated with longer length of hospitalization. The presence of START criteria for anticoagulant is associated with increased risk of intra-hospital death.

Conclusions

The appropriateness of prescription is a global burden especially in older subjects, while it increases the risk of fatal and non-fatal complications, side effects, and, consequently, higher health-care costs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Beard JR, Officer A, de Carvalho IA et al (2016) The World report on ageing and health: a policy framework for healthy ageing. Lancet 387:2145–2154. https://doi.org/10.1016/S0140-6736(15)00516-4

    Article  PubMed  Google Scholar 

  2. Lopreite M, Mauro M (2017) The effects of population ageing on health care expenditure: a Bayesian VAR analysis using data from Italy. Health Policy 121:663–674. https://doi.org/10.1016/j.healthpol.2017.03.015

    Article  PubMed  Google Scholar 

  3. Scuteri A, Lattanzio F, Bernabei R (2016) Life-course approach to chronic disease: the active and healthy aging perspective. J Am Geriatr Soc 64:e59–61. https://doi.org/10.1111/jgs.14271

    Article  PubMed  Google Scholar 

  4. Nilsson PM, Laurent S, Cunha PG et al (2018) Characteristics of healthy vascular ageing in pooled population-based cohort studies: the global metabolic syndrome and artery research consortium. J Hypertens 36:2340–2349. https://doi.org/10.1097/HJH.0000000000001824

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Scuteri A, Morrell CH, Fegatelli DA et al (2019) Arterial stiffness and multiple organ damage: a longitudinal study in population. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01260-0

    Article  PubMed  PubMed Central  Google Scholar 

  6. Masnoon N, Shakib S, Kalisch-Ellett L (2017) What is polypharmacy? A systematic review of definitions. BMC Geriatr 17:230. https://doi.org/10.1186/s12877-017-0621-2

    Article  PubMed  PubMed Central  Google Scholar 

  7. O’Mahony D, O’Sullivan D, Byrne S et al (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44:213–218. https://doi.org/10.1093/ageing/afu145

    Article  PubMed  Google Scholar 

  8. Onder G, Bonassi S, Abbatecola AM et al (2014) High prevalence of poor quality drug prescribing in older individuals: a nationwide report from the Italian Medicines Agency (AIFA). J Gerontol A Biol Sci Med Sci 69:430–437. https://doi.org/10.1093/gerona/glt118

    Article  PubMed  Google Scholar 

  9. Kucukdagli P, Bahat G, Bay I et al (2019) The relationship between common geriatric syndromes and potentially inappropriate medication use among older adults. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01239-x

    Article  PubMed  Google Scholar 

  10. Rochon PA, Gurwitz JH (2017) The prescribing cascade revisited. Lancet 389:1778–1780. https://doi.org/10.1016/S0140-6736(17)31188-1

    Article  PubMed  Google Scholar 

  11. Scondotto G, Pojero F, Pollina Addario S et al (2018) The impact of polypharmacy and drug interactions among the elderly population in Western Sicily, Italy. Aging Clin Exp Res 30:81–87. https://doi.org/10.1007/s40520-017-0755-2

    Article  PubMed  Google Scholar 

  12. Thevelin S, Mounaouar LE, Marien S et al (2019) Potentially inappropriate prescribing and related hospital admissions in geriatric patients: a comparative analysis between the STOPP and START criteria versions 1 and 2. Drugs Aging 36:453–459. https://doi.org/10.1007/s40266-018-00635-8

    Article  PubMed  Google Scholar 

  13. Perez T, Moriarty F, Wallace E et al (2018) Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study. BMJ 363:k4524. https://doi.org/10.1136/bmj.k4524

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fabbietti P, Di Stefano G, Moresi R et al (2018) Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study. Aging Clin Exp Res 30:977–984. https://doi.org/10.1007/s40520-017-0856-y

    Article  PubMed  Google Scholar 

  15. Curtin D, Gallagher PF, O’Mahony D (2019) Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Adv Drug Saf 10:2042098619829431. https://doi.org/10.1177/2042098619829431

    Article  PubMed  PubMed Central  Google Scholar 

  16. Brunetti E, Aurucci ML, Boietti E et al (2019) Clinical implications of potentially inappropriate prescribing according to STOPP/START version 2 criteria in older polymorbid patients discharged from geriatric and internal medicine wards: a prospective observational multicenter study. J Am Med Dir Assoc. https://doi.org/10.1016/j.jamda.2019.03.023

    Article  PubMed  Google Scholar 

  17. Zhang X, Zhou S, Pan K et al (2017) Potentially inappropriate medications in hospitalized older patients: a cross-sectional study using the Beers 2015 criteria versus the 2012 criteria. Clin Interv Aging 12:1697–1703. https://doi.org/10.2147/CIA.S146009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Pardo-Cabello AJ, Manzano-Gamero V, Zamora-Pasadas M et al (2018) Potentially inappropriate prescribing according to STOPP-2 criteria among patients discharged from Internal Medicine: prevalence, involved drugs and economic cost. Arch Gerontol Geriatr 74:150–154. https://doi.org/10.1016/j.archger.2017

    Article  PubMed  Google Scholar 

  19. Hill-Taylor B, Walsh KA, Stewart S et al (2016) Effectiveness of the STOPP/START (Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther 41:158–169. https://doi.org/10.1111/jcpt.12372

    Article  CAS  PubMed  Google Scholar 

  20. Masnoon N, Shakib S, Kalisch-Ellett L et al (2018) Tools for assessment of the appropriateness of prescribing and association with patient-related outcomes: a systematic review. Drugs Aging 35:43–60. https://doi.org/10.1007/s40266-018-0516-8

    Article  PubMed  Google Scholar 

  21. Pazan F, Kather J, Wehling M (2019) A systematic review and novel classification of listing tools to improve medication in older people. Eur J Clin Pharmacol 75:619–625. https://doi.org/10.1007/s00228-019-02634-z

    Article  PubMed  Google Scholar 

  22. Gallagher P, Ryan C, Byrne S et al (2008) STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther 46:72–83. https://doi.org/10.5414/cpp46072

    Article  CAS  PubMed  Google Scholar 

  23. Gibert P, Cabaret M, Moulis M et al (2018) Optimizing medication use in elderly people in primary care: impact of STOPP criteria on inappropriate prescriptions. Arch Gerontol Geriatr 75:16–19. https://doi.org/10.1016/j.archger.2017

    Article  PubMed  Google Scholar 

  24. Moriarty F, Bennett K, Cahir C et al (2016) Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community-dwelling older people: a prospective cohort study. Br J Clin Pharmacol 82:849–857. https://doi.org/10.1111/bcp.12995

    Article  PubMed  PubMed Central  Google Scholar 

  25. Miller MD, Paradis CF, Houck PR et al (1992) Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 41:237–248

    Article  CAS  PubMed  Google Scholar 

  26. Linn BS, Linn MW, Gurel L (1968) Cumulative illness rating scale. J Am Geriatr Soc 16:622–626. https://doi.org/10.1111/j.1532-5415.1968.tb02103.x

    Article  CAS  PubMed  Google Scholar 

  27. Parmelee PA, Thuras PD, Katz IR et al (1995) Validation of the Cumulative Illness Rating Scale in a geriatric residential population. J Am Geriatr Soc 43:130–137. https://doi.org/10.1111/j.1532-5415.1995.tb06377.x

    Article  CAS  PubMed  Google Scholar 

  28. Aboyans V, Ricco JB, Bartelink MEL et al (2018) 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 39:763–816. https://doi.org/10.1093/eurheartj/ehx095

    Article  PubMed  Google Scholar 

  29. Kirchhof P, Benussi S, Kotecha D et al (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18:1609–1678. https://doi.org/10.1093/europace/euw295

    Article  PubMed  Google Scholar 

  30. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  PubMed  PubMed Central  Google Scholar 

  31. McNeil JJ, Wolfe R, Woods RL et al (2018) Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med 379:1509–1518. https://doi.org/10.1056/nejmoa1805819

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Group ASC, Bowman L, Mafham M et al (2018) Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med 379:1529–1539. https://doi.org/10.1056/nejmoa1804988

    Article  CAS  Google Scholar 

  33. Gaziano JM, Brotons C, Coppolecchia R et al (2018) Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet 392:1036–1046. https://doi.org/10.1016/S0140-6736(18)31924-X

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Li L, Geraghty OC, Mehta Z et al (2017) Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. Lancet 390:490–499. https://doi.org/10.1016/S0140-6736(17)30770-5

    Article  PubMed  PubMed Central  Google Scholar 

  35. Pes GM, Errigo A, Bitti A et al (2018) Effect of age, period and birth-cohort on the frequency of glucose-6-phosphate dehydrogenase deficiency in Sardinian adults. Ann Med 50:68–73. https://doi.org/10.1080/07853890.2017.1390247

    Article  CAS  PubMed  Google Scholar 

  36. Zuin M, Rigatelli G, Carraro M et al (2017) Antiplatelet therapy in patients with glucose-6-phosphate dehydrogenases deficiency after percutaneous coronary intervention: a reappraisal for clinical and interventional cardiologists. Cardiovasc Revasc Med 18:226–229. https://doi.org/10.1016/j.carrev.2016.11.011

    Article  PubMed  Google Scholar 

  37. Kristensen SD, Knuuti J, Saraste A et al (2014) 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 35:2383–2431. https://doi.org/10.1093/eurheartj/ehu282

    Article  PubMed  Google Scholar 

  38. Garasto S, Fusco S, Onder G et al (2017) Inappropriate prescription of low molecular weight heparins for thromboprophylaxis among older hospitalized patients. Aging Clin Exp Res 29:483–490. https://doi.org/10.1007/s40520-016-0571-0

    Article  PubMed  Google Scholar 

  39. Manias E, Maier A, Krishnamurthy G (2019) Inappropriate medication use in hospitalised oldest old patients across transitions of care. Aging Clin Exp Res. https://doi.org/10.1007/s40520-018-01114-1

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Geriatrics, University of Sassari, Sassari, Italy

    Marta Manzocco & Angelo Scuteri

  2. Clinica Medica, University of Sassari, Azienda Ospedaliera Universitaria Sassari, Sassari, Italy

    Alessandro Delitala, Sara Serdino & Roberto Manetti

  3. Department of Medical, Surgical, and Experimental Science, University of Sassari, Sassari, Italy

    Roberto Manetti & Angelo Scuteri

Authors
  1. Marta Manzocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Delitala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara Serdino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberto Manetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelo Scuteri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angelo Scuteri.

Ethics declarations

Conflict of interest

No Author has to disclose any conflict of interest that could have direct or potential influence or impart bias on the work.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manzocco, M., Delitala, A., Serdino, S. et al. The appropriateness of antiplatelet and anticoagulant drug prescriptions in hospitalized patients in an internal medicine ward. Aging Clin Exp Res 33, 2849–2855 (2021). https://doi.org/10.1007/s40520-019-01387-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-019-01387-0

Keywords

Search

Navigation