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P-806
Non-vitamin K Oral Anticoagulants (NOACs) in patients with hip
fracture; prevalence of use and implications
I. Linnerud
1,2
, K.K. Viktil
1,2
, M.I. Martinsen
1
, E. Molden
1,2
,
A.H. Ranhoff
1,3
.
1
Diakonhjemmet Hospital,
2
Institute of pharmacy
University of Oslo, Oslo,
3
Department of Clinical Science University of
Bergen, Bergen, Norway
Objectives:
To study prevalence of use of NOACs, and their implica-
tions on waiting-time for surgery, length of stay (LOS), and blood
transfusions in older hip fracture patients. Further, to compare s-
concentrations of NOACS to medication lists, and estimate the half-life
(T1/2) of NOACs in users.
Methods:
A prospective observational study of older (
≥
65 years) hip
fracture patients consecutively included from October 2015 to
February 2016. Medication reconciliation, time for last consumed
dose of NOAC, start of surgery, LOS and blood transfusions were
registered. Blood samples from admission and right before surgery
were analyzed for s-concentration of NOAC to compare with recorded
use and estimate NOAC T1/2.
Results:
We included 167 patients; median age 84 years (range
65
–
101), 122 females (73.1%). 76 (45.5%) used antithrombotic agents;
11(6.6%) NOAC, 15 (9.0%) warfarin and 50 (29.9%) platelet inhibitors.
NOAC-users had longer medianwaiting-time for surgery thanwarfarin
users; i.e. 44 vs 25 hours, p = 0.016. Median LOS was not longer
forNOAC-users than warfarin-users (8 vs 7 days, p = 0.134). Blood
transfusions were given to 36.4% of DOAC-users vs 21.4% of warfarin-
users (p = 0.65) Estimated mean T1/2 of NOACs were 33, 16.5 and 14.5
hours for dabigatran (n = 2), apixaban (n = 4) and rivaroxaban (n = 2),
respectively.
Conclusions:
Almost half of the hip fracture patients used antithrom-
botic agents, but only a minor fraction was treated with NOACs. NOAC-
users had longer waiting-time for surgery and a non-significant
tendency to receive more blood transfusions. For many of the NOAC-
treated patients, the estimated T1/2 was longer than specified in the
product information.
P-807
Drug prescription in the elderly: revaluation of potentially
inappropriate prescribing during hospitalization according to
STOPP and START criteria version 2
M. Richard
1
, P. Gibert
1
, S. Chanoine
1,2
, P. Bedouch
1,2
, B. Allenet
1,2
,
G. Gavazzi
3,4
.
1
Pharmacy Department, Grenoble Alpes University Hospital
(GAUH),
2
TIMC-IMAG UMR 5525/Themas, Grenoble Alpes University
(GAU),
3
University Clinic of Geriatric Medicine, GAUH,
4
CNRS GREPI EA
7308, GAU, France
Objectives:
Polypharmacy and potential inappropriate prescribing
(PIP) are major risk factors for serious adverse drug events (ADE) in the
elderly. Many screening tools for detecting PIP have been developed to
guide physicians in prescribing optimization. The widely used STOPP
and START criteria have demonstrated association between PIP and
avoidable ADE. The main objective of this study was to measure the
revaluation of PIP during the hospital stays according to STOPP criteria
version 2.
Methods:
A cross sectional study has been conducted in a 2000-beds
teaching hospital. All patients over 75 years old of 20 wards were
enrolled to compare prescriptions at admission and discharge, and
assess change in PIP during hospitalization based on STOPP criteria.
Results:
Among the 166 patients included, 56% had PIP at admission.
Although the average number of medicines by patients increased by
18.6% during hospitalization, their prevalence was reduced at
discharge (37%). Among the 150 PIP detected, 56% were stopped
during hospitalization. The main PIP concerned loop diuretics (26.0%),
benzodiazepines (22.7%) and opioid analgesics (13.3%). The majority of
discontinuations were performed in geriatrics units (59.5%), involving
only 32.5% of patients included, while other care units are less involved
in this process.
Conclusion:
The update and the dissemination of our institutional
practice guidelines will encourage health care service, hosting elderly
patients, to pursue this effort. Communication among health care
providers is fundamental to promote the maintenance or the
revaluation of the changes that have been made, at discharge.
P-808
Benefits of pharmaceutical care services in optimizing
pharmacotherapy in the elderly
M. Richard
1
, P. Gibert
1
, S. Chanoine
1,2
, P. Bedouch
1,2
, G. Gavazzi
3,4
,
B. Allenet
1,2
.
1
Pharmacy Department, Grenoble Alpes University Hospital
(GAUH),
2
TIMC-IMAG UMR 5525 / Themas, Grenoble Alpes University
(GAU),
3
University Clinic of Geriatric Medicine, GAUH,
4
CNRS GREPI EA
7308, GAU, France
Objectives:
Treatment optimization is a major public health issue in
the elderly. Different tools like the explicit criteria STOPP and START
have been developed in order to guide physicians and pharmacists in
this process. The objective of this study was to assess the benefits of
pharmaceutical care (PC) on prescriptions revaluation in this specific
population.
Methods:
An observational study has been conducted in a 2000-beds
teaching hospital. All patients over 75 years old hospitalized in 20 care
units (CU), including 10 with PC, were enrolled to compare prescrip-
tions at admission and discharge according to STOPP criteria version
2. Pharmaceutical interventions (PI) performed were collected.
Results:
Among the 166 patients included, 55% were admitted in units
with PC. At admission, 74 and 76 potential inappropriate prescribing
(PIP) were observed in units with PC and others, respectively. During
hospitalization, the revaluation rate of PIP was 53% and 59%,
respectively (p > 0.05). In PC units, 150 PI were proposed in which 7
conducted to stop potentially inappropriate prescriptions. The
majority of PI concerned request for dose adjustment (27.3%) drug
renewal at admission (20.7%), substitutions proposals according to the
drug formulary of our institution (16.0%) or suggestions for discon-
tinuation treatment (12.7%).
Conclusion:
Explicit criteria allow a first approach to revaluation of
prescription by targeting the most high risks drugs. However they
don
’
t cover all the complexity of optimizing prescriptions. Further
assistances coming from PC activity suggest other areas of improve-
ment, making multidisciplinary collaboration involving clinical phar-
macists essential.
P-809
Polypharmacy in the elderly and the Internal Medicine ward
–
an
observational study in a Portuguese tertiary hospital
A. Rola, J. Monteiro.
C.H.P.
Introduction:
Polypharmacy is an ambiguous term applied to an
evergrowing number of elderly patients. No standard definition exists,
with most studies embracing the arbitrary number of five or more
prescribed medications to define the term. Only a few studies exist
regarding this issue during hospitalization.
Methods:
We analyzed a randomized sample of 299 elderly patients
from a 1231 universe admitted between January 1st and the 30th of
June in all Internal Medicine wards at a tertiary Portuguese hospital,
comparing the number of medications being prescribed on admission
and discharge dates. Data were taken consulting admission and
discharge summaries from clinical electronic records. The number of
diagnostics made, patient functional status, and existing cognitive
deficit were taken into account. Patients who died during hospital
admission were excluded.
Results:
On admission, 81.27% (n = 243) of elderly patients were taking
five or more medications, and 29.77% (n = 89) ten or more. On
discharge, 79.93% (n = 239) and 29.43% (n = 88) of patients, respect-
ively. Of the 25.41% (n = 76) of totally dependent patients, 18.73%
(n = 56) were polymedicated at both moments, with 21 patients
having ten or more drugs on admission, versus 14 on discharge. Of the
totally dependent and cognitively impaired patients, 16.05% (n = 48)
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S242