Abstract 3527: Decline in GP 2b3a Inhibitor Overdosing with Site-Specific Feedback in CRUSADE
Background: Glycoprotein (GP) 2b3a inhibitors are recommended by guidelines for the treatment of invasively managed patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), but their frequent overdosing contributes to increased bleeding. The impact of site-specific safety feedback (GP 2b3a overdosing) has not been previously described.
Methods: Among hospitals that continuously submitted data to the CRUSADE quality improvement initiative from the 4th quarter (Q4) 2005 through Q4 2006, we trended excess GP 2b3a dosing among the 11,846 NSTE ACS patients who received them. Excess dosing of GP 2b3a inhibitors was defined based on package labeling as no dose reduction for reduced CrCl. Dosing feedback was added to the CRUSADE site reports in Q1 2006. Rates of excess dosing overall and among women and the elderly (age ≥ 75 years) as well as bleeding and transfusion among those treated with GP 2b3a (excluding those who underwent coronary artery bypass graft surgery or were transferred out) are shown by quarter and tested for trends.
Results: The use of GP 2b3a inhibitors varied slightly (52–54%) over the time interval. Of the 11,846 who received GP 2b3a inhibitors, 4,031 were women and 2,609 were elderly (age ≥ 75 years). The rate of excess dosing declined significantly overall, but particularly among women and the elderly (Table⇓). Major bleeding declined from Q4 2005 to Q4 2006 overall (9.3 to 7.9%, p=.02), among women (13.9 to 11.7%, p=NS), and among the elderly (16.6 to 11.7%, p=NS). Red blood cell transfusion rates also declined overall (6.1 to 4.8%, p=.006), among women (10.1 to 8.5%, p=NS), and among the elderly (14.9 to 8.4%, p=.02).
Conclusion: After initiation of safety feedback, excess dosing of GP 2b3a inhibitors and bleeding declined simultaneously demonstrating an influence on practice and outcomes. However, a third of women and half of the elderly continue to receive excess doses, so more efforts are needed to optimize safety.