Evaluation of Prasugrel Use When Contraindications Are Present on an Inpatient Cardiovascular Surgery Stepdown Unit

Indianapolis, IN

Our primary objective is to determine the rate of inappropriate use of prasugrel, and if administration of prasugrel to patients with a prior transient ischemic attack (TIA) or stroke causes additional bleeding events. Our secondary objective is to identify any patient demographics or risk factors for increased bleeding events after prasugrel administration. Although prasugrel is contraindicated in patients that have suffered a prior TIA or stroke, pharmacists noticed that this medication was being prescribed for this patient population. All data relevant to patients receiving prasugrel who suffered a TIA or stroke before or after receiving prasugrel will be analyzed. We hope to determine the impact of this inappropriate use in order to implement steps to prevent future negative health outcomes. A retrospective analysis will be performed on all qualifying patients. Inclusion criteria includes all patients admitted to the cardiovascular surgery stepdown unit from June 2016 to June 2017 who received at least one dose of prasugrel. After de-identifying patient sensitive data, a chart review will be conducted to collect all data points. Data points include: admission date, readmission in 30 days, hospital admit diagnosis, length of stay, length of antiplatelet therapy, intensive care unit length of stay, anticoagulation (Y/N), anticoagulants received, stroke/TIA (Y/N), date of stroke/TIA, prasugrel administration relative to stroke (before/after), trauma, previous GI bleed, nonsteroidal anti-inflammatory drug use, surgical history, bleeding events before or after prasugrel administration, allergic reaction, stomach or intestinal bleeding, weight less than 132 pounds, and liver or kidney dysfunction. Once data is collected, data analysis will be primarily analyzed using descriptive statistics, such as number of patients, means, and rates.