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Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Purpose

The objective of this study was to identify the most clinically relevant drug–drug interactions (DDIs) at risk of affecting acenocoumarol safety in our tertiary care university hospital, a 2,000 bed institution.

Methods

We identified DDIs occurring with acenocoumarol by combining two different sources of information: a 1-year retrospective analysis of acenocoumarol prescriptions and comedications from our Computerized Physician Order Entry (CPOE) system (n = 2,439 hospitalizations) and a retrospective study of clinical pharmacology consultations involving acenocoumarol over the past 14 years (1994–2007) (n = 407). We classified these DDIs using an original risk-analysis method. A criticality index was calculated for each associated drug by multiplying three scores based on mechanism of interaction, involvement in a supratherapeutic international normalized ratio (INR) (≥ 6) and involvement in a severe bleeding.

Results

One hundred and twenty-six DDIs were identified and weighted. Twenty-eight drugs had a criticality index ≥ 20 and were therefore considered at high risk for interacting with acenocoumarol by increasing its effect: 75% of these drugs involved a pharmacokinetic mechanism and 14 % a pharmacodynamic mechanism. An unknown mechanism of interaction was involved in 11 % of drugs.

Conclusion

Twenty-eight specific drugs were identified as being at high risk for interacting with acenocoumarol in our hospital using an original risk-analysis method. Most analyzed drugs interact with acenocoumarol via a pharmacokinetic mechanism. Actions such as the implementation of alerts in our CPOE system should be specifically developed for these drugs.

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Authors and Affiliations

  1. Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland

    L. Gschwind, V. Rollason, P. Dayer & J. A. Desmeules

  2. School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland

    P. Bonnabry

  3. Division of Medical Information Sciences, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland

    C. Lovis

  4. Division of Angiology and Haemostasis, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland

    F. Boehlen

  5. Pharmacy, University Hospitals of Geneva, Geneva, Switzerland

    P. Bonnabry

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  1. L. Gschwind
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  2. V. Rollason
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  3. C. Lovis
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  4. F. Boehlen
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  5. P. Bonnabry
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Correspondence to L. Gschwind.

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Gschwind, L., Rollason, V., Lovis, C. et al. Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital. Eur J Clin Pharmacol 69, 617–627 (2013). https://doi.org/10.1007/s00228-012-1358-7

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