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Determinação do risco potencial de interações medicamentosas prolongadoras do intervalo QT em idosos internados em unidade de terapia intensiva
Determination of the potential risk of QT-prolonging drug interactions in elderly patients admitted to an intensive care unit
Determinación del riesgo potencial de las interacciones farmacológicas que prolongan el intervalo QT en ancianos hospitalizados en una unidad de cuidado intensivo
DOI:
https://doi.org/10.15446/rcciquifa.v51n2.98897Palabras clave:
Interações Medicamentosas, Síndrome do QT Longo, Idoso, unidade de terapia intensiva (pt)Drug Interactions, Long QT Syndrome, Aged, Intensive Care Units (en)
Interacciones Farmacológicas, Síndrome de QT Prolongado, Anciano, Unidades de Cuidados Intensivos (es)
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Introdução: pacientes hospitalizados em unidade de terapia intensiva, em especial idosos, são particularmente expostos a interações medicamentosas prolongadoras do intervalo QT. Objetivo: determinar a incidência de interações medicamentosas prolongadoras do intervalo QT potenciais (IMQT) e seus preditores clínicos e tera-pêuticos em idosos hospitalizados em unidade de terapia intensiva. Metodologia:coorte retrospectiva conduzida em unidade de terapia intensiva adulto. Foram incluídos prontuários de pacientes com idade igual ou superior a 60 anos com tempo de internação mínimo de 24 h e que utilizaram dois ou mais medicamentos. O Credi-bleMeds foi utilizado para classificação dos medicamentos com risco de prolongar o intervalo QT; em seguida, o Micromedex foi acessado para identificar e classificar as interações medicamentosas. Preditores clínicos e terapêuticos das interações foram examinados a partir de um modelo de regressão logística múltiplo. Resultados: a incidência de IMQT potenciais foi de 43,9 %. Os medicamentos mais frequentemente combinados nas IMQT potenciais foram ondansetrona (25 %), quetiapina (22,5 %), amiodarona (18,6 %) e haloperidol (17,5 %). As IMQT potenciais mais frequentes foram haloperidol + ondansetrona (25,4 %) seguidas pela dupla ondansetrona + quetiapina (13,1 %). Os preditores de IMQT potenciais foram uso de polifar-mácia (p=0,002), antipsicóticos (p<0,001), antidepressivos (p< 0,001) e antiarrítmicos (p=0,002). Conclusão: a gestão das IMQT requer abordagem pautada em fatores de risco individuais e também, obrigatoriamente, em condutas genéricas rela-tivas a exames bioquímicos, instalação de monitores cardíacos, eletrocardiogramas periódicos e uso de sistemas de alerta para IMQT.
Introduction: Patients hospitalized in the intensive care unit, especially the elderly, are particularly exposed to drug interactions that prolong the QT interval. AIM: To determine the incidence of potential QT-prolonging drug interactions (IMQT) and their clinical and therapeutic predictors in elderly patients hospitalized in an inten-sive care unit. Methodology: Retrospective cohort conducted in an adult inten-sive care unit. Medical records of patients aged 60 years or older with a minimum hospital stay of 24 hours and who used two or more medications were included. CredibleMeds was used to classify drugs at risk of prolonging the QT interval; then, Micromedex was accessed to identify and classify drug interactions. Clinical and therapeutic predictors of interactions were examined using a multiple logistic regres-sion model. Results: The incidence of potential IMQT was 43.9 %. The drugs most frequently combined in potential MTMI were ondansetron (25 %), quetiapine (22.5 %), amiodarone (18.6 %) and haloperidol (17.5 %). The most frequent poten-tial MTMI were haloperidol + ondansetron (25.4 %) followed by the dual ondanse-tron + quetiapine (13.1 %). Potential IMQT predictors were use of polypharmacy (p=0.002), antipsychotics (p<0.001), antidepressants (p<0.001) and antiarrhyth-mics (p=0.002). Conclusion: The management of IMQT requires an approach based on individual risk factors and also, necessarily, on generic conducts related to biochemical tests, installation of cardiac monitors, periodic electrocardiograms and use of warning systems for IMQT.
Introducción: los pacientes hospitalizados en la unidad de cuidados intensivos, espe-cialmente los ancianos, están particularmente expuestos a interacciones medicamen-tosas que prolongan el intervalo QT. Objetivo: determinar la incidencia de posibles interacciones medicamentosas prolongadoras del intervalo QT (IMQT) y sus predic-tores clínicos y terapéuticos en pacientes ancianos hospitalizados en una unidad de cuidados intensivos. Metodología: cohorte retrospectiva realizada en una unidad de cuidados intensivos para adultos. Se incluyeron historias clínicas de pacientes de 60 años o más con una estancia hospitalaria mínima de 24 horas y que utilizaban dos o más medicamentos. Se utilizó CredibleMeds para clasificar los fármacos con riesgo de prolongar el intervalo QT; luego, se accedió a Micromedex para identificar y clasificar las interacciones medicamentosas. Los predictores clínicos y terapéuticos de interacciones se examinaron mediante un modelo de regresión logística múltiple. Resultados: la incidencia de IMQT potencial fue del 43,9 %. Los fármacos combi-nados con mayor frecuencia en posibles MTMI fueron ondansetrón (25 %), quetia-pina (22,5 %), amiodarona (18,6 %) y haloperidol (17,5 %). Los MTMI potenciales más frecuentes fueron haloperidol + ondansetrón (25,4 %) seguido de ondansetrón dual + quetiapina (13,1 %). Los posibles predictores del IMQT fueron el uso de polifarmacia (p=0,002), antipsicóticos (p<0,001), antidepresivos (p<0,001) y antia-rrítmicos (p=0,002). Conclusión: el manejo del IMQT requiere un abordaje basado en factores de riesgo individuales y también, obligatoriamente, en conductas genéricas relacionadas con pruebas bioquímicas, instalación de monitores cardíacos, electrocar-diogramas periódicos y uso de sistemas de alerta para IMQT.
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