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Many Dialysis Patients Get Wrong Blood Thinners for Angioplasty
Date:12/8/2009

f use and convenience may also play a role in doctors' turning to these particular drugs, Tsai said.

Meanwhile, the population of people undergoing dialysis is also exploding, and is projected to pass the 2 million mark worldwide by 2010, according to the study.

Angioplasty, also known as percutaneous coronary intervention (PCI), involves widening a blood vessel to ease the flow of blood in patients with narrowed arteries.

For this study, data on 22,778 dialysis patients who had undergone PCI between 2004 and 2008 revealed that 22.3 percent received a blood thinner they should not have been getting. Almost half received enoxaparin and almost two-thirds eptifibatide. About 11 percent received both.

Those patients who did receive a contraindicated drug had a 66 percent higher risk of in-hospital bleeding, and there was some indication that mortality risk might have been elevated as well.

"There was a signal towards increased in-hospital mortality ... so there is a possible trend," Tsai said, adding that this linkage was not yet certain.

Such errors could be introduced at any step in the continuum of care, from the emergency room to the cath lab and anywhere in between, Dehmer said.

"This reflects poorly on the entire process of care, which may start at the outlying hospital or may start in the cath lab," he said. "This represents a very strong call to action on the part of all those who are involved with the care of patients who ultimately wind up having PCI."

Health-care providers do have access to alternative blood thinners when treating this group of patients.

And these contraindicated drugs might even work in hemodialysis patients at the right doses, it's just that no one has ever looked at this, explained Dr. William O'Neill, executive dean for clinical affairs at the University of Miami Miller School of Medicine.

"Poor kidney function almost always disqualifies
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