Pharmacotherapy Evaluation and Utilization in Coronary Artery Bypass Grafting Patients in Kosovo during the Period 2016-2017
DOI:
https://doi.org/10.3889/oamjms.2018.132Keywords:
Coronary Artery Bypass Grafting, Pharmacotherapy, Drug UtilizationAbstract
BACKGROUND: Coronary Artery Bypass Grafting (CABG) is realized in patients with critical or advanced disease of coronary arteries. There are different pharmacotherapeutic approaches which are used as management, treatment and preventive therapy in cardiovascular disease or related comorbidities. Performing a successful surgery, pharmacotherapy, and increase of bypass patency rate still remains a serious challenge.
AIM: The aim of this study is to analyze the patient characteristics undergoing CABG and eval-uation of their drug utilization rate and daily dosages in the perioperative period.
MATERIAL AND METHODS: Data were collected from 102 patients in the period 2016-2017 and detailed therapeutic prescription and dosages, patient characteristics were analyzed before the operation, after the operation and visit after operation in the Clinic of Cardiac surgery-University Clinical Center of Kosovo.
RESULTS: Our findings have shown that patients provided to have normal biochemical parameters in the clinic before the operation, and were related to cardiovascular diseases and comorbidities and risk factors with mainly elective intervention. However higher utilization of cardiovascular drugs such as beta blockers, diuretics, anticoagulants, statins and lower calcium blockers, ACEi, ARBs, hydrochlorothiazide, amiodarone were founded. ARBs, beta blockers, statins, nitrates and nadroparin utilization decreased after operation and visit after the operation, whereas amiodarone only in the visit after the operation. Diuretics are increased after the operation which decreases in the visit after the operation. Regarding the daily dosage, only metoprolol was increased in the visit after operation (P < 0.001) and visit after operation (P < 0.05) whereas losartan and furosemide were increased (P < 0.01) and (P < 0.05) respectively.
CONCLUSION: The study showed that beta blockers, statins, aspirin, nitrates (before the operation), furosemide and spironolactone are the most utilized drugs. However, we found low utilization rate for ACEi, ARBs, clopidogrel, nadroparin, warfarin, xanthines, amiodarone, calcium blockers. Daily dosages were different compared to before CABG only in metoprolol, losartan, and furosemide.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: Epidemiological update 2016. Eur Heart J. 2016; 37:3232–45. https://doi.org/10.1093/eurheartj/ehw334 PMid:27523477
Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics-2011 update: A report from the American Heart Association. Circulation. 2011; 123(4). https://doi.org/10.1161/CIR.0b013e3182009701
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014; 129(3):e28–292. https://doi.org/10.1161/01.cir.0000441139.02102.80 PMid:24352519 PMCid:PMC5408159
Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011; 473:317–25. https://doi.org/10.1038/nature10146 PMid:21593864
Salisbury D, Bronas U. Inflammation and Immune System Contribution to the Etiology of Atherosclerosis. Nurs Res. 2014; 63(5):375–85. https://doi.org/10.1097/NNR.0000000000000053 PMid:25171563
Badimon L, Vilahur G. Thrombosis formation on atherosclerotic lesions and plaque rupture. Journal of Internal Medicine. 2014; 276:618–32. https://doi.org/10.1111/joim.12296 PMid:25156650
Hense HW. Risk factor scoring for coronary heart disease: Prediction algorithms need regular updating. Br Medicaj J. 2003; 327(7426):1238. https://doi.org/10.1136/bmj.327.7426.1238 PMid:14644935 PMCid:PMC286233
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, DiSesa VJ, Hiratzka LF, Hutter AM, Jessen ME. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. Journal of the American College of Cardiology. 2011; 58(24):e123-210. https://doi.org/10.1016/j.jacc.2011.08.009 PMid:22070836
Cannon CP, Harrington RA, James S, Ardissino D, Becker RC, Emanuelsson H, et al. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study. Lancet. 2010; 375(9711):283–93. https://doi.org/10.1016/S0140-6736(09)62191-7
Goldman S, Zadina K, Moritz T, Ovitt T, Sethi G, Copeland JG, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004; 44(11):2149–56. https://doi.org/10.1016/j.jacc.2004.08.064 PMid:15582312
Kim FY, Marhefka G, Ruggiero NJ, Adams S, Whellan DJ. Saphenous vein graft disease: review of pathophysiology, prevention, and treatment. Cardiol Rev. 2013; 21(2):101–9. https://doi.org/10.1097/CRD.0b013e3182736190 PMid:22968180
Foudi N, Kotelevets L, Gomez I, Louedec L, Longrois D, Chastre E, et al. Differential reactivity of human mammary artery and saphenous vein to prostaglandin E(2) : implication for cardiovascular grafts. Br J Pharmacol. 2011; 163(4):826–34. https://doi.org/10.1111/j.1476-5381.2011.01264.x PMid:21323896 PMCid:PMC3111684
Gao G, Zheng Z, Pi Y, Lu B, Lu J, Hu S. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery: A single-center, randomized, controlled trial. J Am Coll Cardiol. 2010; 56(20):1639–43. https://doi.org/10.1016/j.jacc.2010.03.104 PMid:21050973
Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg. 2013;257(5):824–33. https://doi.org/10.1097/SLA.0b013e318288c38d PMid:23574989
Zhu Y, Chen A, Wang Z, Liu J, Cai J, Zhou M ZQ. Ten-year real-life effectiveness of coronary artery bypass using radial artery or great saphenous vein grafts in a single centre. Cardiovasc Thoratic Surg. 2017; 2017.
Brown C, Joshi B, Faraday N, Shah A, Yuh D, Rade JJ, et al. Emergency cardiac surgery in patients with acute coronary syndromes: A review of the evidence and perioperative implications of medical and mechanical therapeutics. Anesth Analg. 2011; 112(4):777–99. https://doi.org/10.1213/ANE.0b013e31820e7e4f PMid:21385977 PMCid:PMC3063855
Goyal A, Alexander JH, Hafley GE, Graham SH, Mehta RH, Mack MJ, et al. Outcomes Associated With the Use of Secondary Prevention Medications After Coronary Artery Bypass Graft Surgery. Ann Thorac Surg. 2007; 83(3):993–1001. https://doi.org/10.1016/j.athoracsur.2006.10.046 PMid:17307447
Barry AR, Koshman SL, Norris CM, Ross DB, Pearson GJ. Evaluation of preventive cardiovascular pharmacotherapy after coronary artery bypass graft surgery. Pharmacotherapy. 2014; 34(5):464–72. https://doi.org/10.1002/phar.1380 PMid:24877186
Williams JB, DeLong ER, Peterson ED, Dokholyan RS, Ou FS, Ferguson TB. Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice. Circulation. 2011; 123(1):39–45 7.
Wann LS, Curtis AB, January CT, Ellenbogen KA, Lowe JE, Estes NAM, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): A report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation. 2011; 123(1):104–23. https://doi.org/10.1161/CIR.0b013e3181fa3cf4 PMid:21173346
Bin C, Junsheng M, Jianqun Z, Ping B. Meta-Analysis of Medium and Long-Term Efficacy of Loading Statins After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2016; 101(3):990–5. https://doi.org/10.1016/j.athoracsur.2015.08.075 PMid:26518376
Davis EM, Packard K a, Hilleman DE. Pharmacologic prophylaxis of postoperative atrial fibrillation in patients undergoing cardiac surgery: beyond beta-blockers. Pharmacotherapy. 2010; 30:749, 274e–318e.
Daci A, Neziri B, Krasniqi S, Cavolli R, Alaj R, Norata GD, Beretta G. Arctigenin improves vascular tone and decreases inflammation in human saphenous vein. European journal of pharmacology. 2017; 810:51-6. https://doi.org/10.1016/j.ejphar.2017.06.004 PMid:28603045
Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J, et al. Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease. Journal of the American College of Cardiology. 2006; 47:864–70. https://doi.org/10.1016/j.jacc.2005.09.072 PMid:16487857
Johansson B, Samano N, Souza D, Bodin L, Filbey D, Mannion JD, et al. The no-touch vein graft for coronary artery bypass surgery preserves the left ventricular ejection fraction at 16 years postoperatively: long-term data from a longitudinal randomised trial. Open Hear. 2015; 2(1):e000204. https://doi.org/10.1136/openhrt-2014-000204 PMid:25852948 PMCid:PMC4379882
Ferguson TB, Coombs LP, Peterson ED. Preoperative beta-blocker use and mortality and morbidity following CABG surgery in North America. JAMA. 2002; 287(17):2221–7. https://doi.org/10.1001/jama.287.17.2221 PMid:11980522
Kohsaka S, Miyata H, Motomura N, Imanaka K, Fukuda K, Kyo S, et al. Effects of preoperative β-blocker use on clinical outcomes after coronary artery bypass grafting: A report from the Japanese cardiovascular surgery database. Anesthesiology. 2016; 124(1):45–55. https://doi.org/10.1097/ALN.0000000000000901 PMid:26517856
Brinkman W, Herbert MA, O'Brien S, Filardo G, Prince S, Dewey T, et al. Preoperative β-Blocker Use in Coronary Artery Bypass Grafting Surgery. JAMA Intern Med. 2014; 174(8):1320. https://doi.org/10.1001/jamainternmed.2014.2356 PMid:24934977
Hlatky MA, Solomon MD, Shilane D, Leong TK, Brindis R, Go AS. Use of medications for secondary prevention after coronary bypass surgery compared with percutaneous coronary intervention. J Am Coll Cardiol. 2013; 61(3):295–301. https://doi.org/10.1016/j.jacc.2012.10.018 PMid:23246391
Kalavrouziotis D, Buth KJ, Cox JL, Baskett RJ. Should all patients be treated with an angiotensin-converting enzyme inhibitor after coronary artery bypass graft surgery? the impact of angiotensin-converting enzyme inhibitors, statins, and β-blockers after coronary artery bypass graft surgery. Am Heart J. 2011; 162(5):836–43. https://doi.org/10.1016/j.ahj.2011.07.004 PMid:22093199
Ouzounian M, Buth KJ, Valeeva L, Morton CC, Hassan A, Ali IS. Impact of preoperative angiotensin-converting enzyme inhibitor use on clinical outcomes after cardiac surgery. Ann Thorac Surg. 2012; 93(2):559–64. https://doi.org/10.1016/j.athoracsur.2011.10.058 PMid:22269723
Bandeali SJ, Kayani WT, Lee V-V, Pan W, Elayda MA a., Nambi V, et al. Outcomes of Preoperative Angiotensin-Converting Enzyme Inhibitor Therapy in Patients Undergoing Isolated Coronary Artery Bypass Grafting. Am J Cardiol. 2012; 110(7):919-23. https://doi.org/10.1016/j.amjcard.2012.05.021 PMid:22727178
Bandeali SJ, Kayani WT, Lee VV, Elayda M, Alam M, Huang HD, et al. Association between preoperative diuretic use and in-hospital outcomes after cardiac surgery. Cardiovasc Ther. 2013; 31(5):291–7. https://doi.org/10.1111/1755-5922.12024 PMid:23517524
Hansen KH, Hughes P, Steinbrüchel DA. Antithrombotic- and anticoagulation regimens in OPCAB surgery. A Nordic survey. Scand Cardiovasc J. 2005; 39(6):369–74. https://doi.org/10.1080/14017430500199428 PMid:16352490
Kulik A, Voisine P, Mathieu P, Masters RG, Mesana TG, Le May MR, et al. Statin therapy and saphenous vein graft disease after coronary bypass surgery: analysis from the CASCADE randomized trial. Ann Thorac Surg. 2011; 92(4):1281–4. https://doi.org/10.1016/j.athoracsur.2011.04.107 PMid:21958773
Kulik A, Ruel M. Statins and coronary artery bypass graft surgery: preoperative and postoperative efficacy and safety. Expert Opin Drug Saf. 2009; 8(5):559–71. https://doi.org/10.1517/14740330903188413 PMid:19673591
Okrainec K, Pilote L, Platt R, Eisenberg MJ. Use of cardiovascular medical therapy among patients undergoing coronary artery bypass graft surgery: results from the ROSETTA-CABG registry. Can J Cardiol. 2006; 22(10):841–7. https://doi.org/10.1016/S0828-282X(06)70302-6
Turley AJ, Roberts AP, Morley R, Thornley AR, Owens WA, de Belder M. Secondary prevention following coronary artery bypass grafting has improved but remains sub-optimal: the need for targeted follow-up. Interact Cardiovasc Thorac Surg. 2008; 7(2):231–4. https://doi.org/10.1510/icvts.2007.168948 PMid:18234766
Alburikan KA, Nazer RI. Use of the guidelines directed medical therapy after coronary artery bypass graft surgery in Saudi Arabia. Saudi Pharmaceutical Journal. 2017; 25(6):819-22. https://doi.org/10.1016/j.jsps.2016.12.007 PMid:28951664 PMCid:PMC5605885
Krzych LJ. Treatment of hypertension in patients undergoing coronary artery by-pass grafting. Curr Opin Pharmacol. 2012; 12(2):127–33. https://doi.org/10.1016/j.coph.2012.01.008 PMid:22342165
Szychta W, Majstrak F, Opolski G, Filipiak KJ. Trends in pharmacological therapy of patients referred for coronary artery bypass grafting between 2004 and 2008: A single-centre study. Kardiologia Polska. 2015; 73:1317–26. https://doi.org/10.5603/KP.a2015.0094 PMid:25987400
Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, et al. Secondary prevention after coronary artery bypass graft surgery: A scientific statement from the American Heart Association. Circulation. 2015; 131(10):927-64. https://doi.org/10.1161/CIR.0000000000000182 PMid:25679302
Esmail M, Nilufar D, Majid GE, Reza TN, Abolfazl M, M. E, et al. Prophylactic effect of amiodarone in atrial fibrillation after coronary artery bypass surgery; a double-blind randomized controlled clinical trail. J Cardiovasc Dis Res. 2015; 6(1):12–7. https://doi.org/10.5530/jcdr.2015.1.2
Munnee K, Bundhun PK, Quan H, Tang Z. Comparing the Clinical Outcomes Between Insulin-treated and Non-insulin-treated Patients With Type 2 Diabetes Mellitus After Coronary Artery Bypass Surgery: A Systematic Review and Meta-analysis. Medicine (Baltimore). 2016; 95(10):e3006. https://doi.org/10.1097/MD.0000000000003006 PMid:26962814 PMCid:PMC4998895
Oh AL, Tan AG, Phan HS, Lee BC, Jumaat N, Chew SP, et al. Indication of acid suppression therapy and predictors for the prophylactic use of proton-pump inhibitors vs. histamine-2 receptor antagonists in a Malaysian tertiary hospital. Pharm Pract (Granada). 2015; 13(3):633–633. https://doi.org/10.18549/PharmPract.2015.03.633 PMid:26445624 PMCid:PMC4582748
Kulik A, Bykov K, Choudhry NK, Bateman BT. Non-steroidal anti-inflammatory drug administration after coronary artery bypass surgery: Utilization persists despite the boxed warning. Pharmacoepidemiol Drug Saf. 2015; 24(6):647–53. https://doi.org/10.1002/pds.3788 PMid:25907164
Baker WL, Anglade MW, Baker EL, White CM, Kluger J, Coleman CI. Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications: a meta-analysis. European Journal of Cardio-thoracic Surgery. 2009; 35:521–7. https://doi.org/10.1016/j.ejcts.2008.11.027 PMid:19147369
Daci A, Özen G, Uyar İ, Civelek E, Yildirim Fİ, Durman DK, Teskin Ö, Norel X, Uydeş-Doğan BS, Topal G. Omega-3 polyunsaturated fatty acids reduce vascular tone and inflammation in human saphenous vein. Prostaglandins & other lipid mediators. 2017; 133:29-34. https://doi.org/10.1016/j.prostaglandins.2017.08.007 PMid:28838848
Jeremy JY, Shukla N, Angelini GD, Wan S. Endothelin-1 (ET-1) and vein graft failure and the therapeutic potential of ET-1 receptor antagonists. Pharmacological Research. 2011; 63: 483–9. https://doi.org/10.1016/j.phrs.2010.10.018 PMid:21056670
Toller W, Heringlake M, Guarracino F, Algotsson L, Alvarez J, Argyriadou H, et al. Preoperative and perioperative use of levosimendan in cardiac surgery: European expert opinion. International Journal of Cardiology. 2015; 184:323–36. https://doi.org/10.1016/j.ijcard.2015.02.022 PMid:25734940
Trivedi C, Upadhyay A, Solanki K. Efficacy of ranolazine in preventing atrial fibrillation following cardiac surgery: Results from a meta-analysis. Journal of Arrhythmia. 2017; 33:161–6. https://doi.org/10.1016/j.joa.2016.10.563 PMid:28607609 PMCid:PMC5459427
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0
