The field of medicine has long adhered to the principle of "first, do no harm," emphasizing the importance of safe and effective management. In recent years, the focus has shifted from treatment’s safety to broader patient safety, especially in the context of the WHO Global Patient Safety Challenge: Medicines Without Harm [1]. This transition underscores the need to minimize medication errors and adverse drug reactions.
Polypharmacy is recognized as a serious modern healthcare challenge and can be categorized into doctor-prescribed and patient-driven polypharmacy. The first one involves prescriptions from physicians, while another encompasses drugs chosen and used by the patient. The aging population, coupled with a trend toward "rejuvenating" diseases, contributes to increased medication use. Inappropriate polypharmacy, defined as the simultaneous use of multiple drugs, has been identified as a significant healthcare concern due to its potential for adverse drug interactions and its impact on health outcomes and resource costs. Addressing polypharmacy involves strategies such as deprescribing, multi-target monotherapy, and bioregulatory therapy. Deprescribing entails physicians revising or canceling prescriptions when the benefits no longer outweigh the risks. Multi-target monotherapy involves using one drug (poly pill) effective for treating various patient’s diseases. Bioregulatory therapy focuses on preventing and treating conditions with minimal side effects and limited drug interactions [2].
This study investigated the formation of the safety profile of modern pharmacotherapy in patients with a high cardiovascular risk, with a particular emphasis on polypharmacy as the planned use of five or more drugs simultaneously. We explored the negative effects of polypharmacy and emphasizes the risks associated with excessive medicine consumption in patients with high cardiovascular patterns. We studied side reactions of drugs, particularly in the context of modern anticoagulant/antiplatelet therapy in cardiovascular patients, their risks were assessed at the Gastrointestinal Bleeding Center at City Clinical Hospital No.12 in Kyiv.
As far as well-understanding, polypharmacy poses several risks, including increased frequency of side effects, negative drug interactions, cascading prescriptions, and a financial burden on healthcare budgets. Excessive use of drugs accumulates harmful substances in the body, slowing down the desired treatment effects and increasing the duration and side effects of drug use. While commonly associated with the elderly, the risk group for polypharmacy extends to those with accompanying disorders, mental illnesses, antidepressants or a natural alternative: how to preserve mental health during war harm disaster, recent hospitalizations, and those using multiple prescriptions. So, adverse drug reactions often result from violations or disregard of medical use recommendations, modern pharmacotherapy protocols, or self-medication.
And the scale of the problem is large. According to statistics, among the 32 million people who are hospitalized annually in the United States, 1.5 million cases are related to the consequences of the use of drugs. Moreover, 30,000 of those hospitalized die from complications of pharmacotherapy. Many people are hospitalized because of the frequent use of many drugs [3]. In the USA, a 65-year-old receives an average of 10.7 new and refilled prescriptions per year [4].In Italy, 40% of people over the age of 70 take 4 to 6 medications daily, and 12% receive more than 9 medications at the same time [5]. It was established that drug interactions occur in 6% of patients against the background of simultaneous use of 2-3 drugs, and when 5 drugs are used, their number increases to 50%, while in patients who receive more than 10 drugs, adverse reactions are almost guaranteed to develop [6].
Open data on the situation in Ukraine has not been found, but there is no reason to believe that it is fundamentally different. Our results estimated that common errors include incorrect drug dosage, intoxication from drug interactions, and false test results. In high-risk patients we found incorrect drug dosage (up to 26%), especially with anticoagulants, and suboptimal prescription of ASA and statins to patients for whom it was indicated and who had no contraindications to the prescription (up to 30%) were prevalent. Thus, according to spontaneous reports, we determined that in one year in Ukraine, when using 5 or more drugs, up to 32.5% of side effects were detected [7].
Our study emphasizes the importance of balancing ischemic and hemorrhagic risks in patients with acute coronary syndrome, congestive heart failure and increased bleeding probability. The most common errors are incorrect dosage of drugs, intoxication due to their interaction in case of impaired kidney/liver function, false test results. The most frequent adverse events appeared with accompanying diseases as oncological and neuropsychiatric disorders, heart/kidney/liver insufficiency, and hypotension. The acceptable safety of modern cardiac drugs used in combination in patients with comorbidity according to international recommendations is known. The main components of cardiovascular risks of patients have been determined, the safety profile of pharmacotherapy involves the use of measures to prevent actions that may harm the patient.
Thus, polypharmacy presents significant challenges to patient health, emphasizing the need for conscious collaboration between physicians and patients. Strategies like deprescribing and bioregulatory therapy offer promising approach for mitigating the risks associated with polypharmacy. Future efforts should prioritize patient safety, education, and awareness regarding appropriate medication use. Most adverse drug reactions rank from non-compliance with approved guidelines or self-medication. Anticoagulant/antiplatelet therapy demands high vigilance due to the risk of adverse reactions, particularly bleeding. The study advocates for individualized dual/triple therapy in high-risk cardiovascular patients and emphasizes factors such as previous massive bleeding, risk assessment using scales, and socio-economic considerations in treatment adherence.
Keywords: polypharmacy, cardiovascular risk, medical error, side effects of drugs, comorbidity
REFERENCES
1. Medication Without Harm https://www.who.int/initiatives/medication-without-harm
2. Medication safety in polypharmacy: technical report/20 June 2019 | Technical document https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.11
3. J Lazarou 1, B H Pomeranz, P N Corey Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies JAMA 1998 Apr 15;279(15):1200-5. doi: 10.1001/jama.279.15.1200.
4. Medication overload and older Americans https://lowninstitute.org/projects/
5. R.Maher, J.Hanlon, E.Hajjar Clinical Consequences of Polypharmacy in Elderly//Expert Opin Saf. 2014 Jan; 13(1) Drug: 10.1517/ 14740338 .2013.827660.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/
6. M Ismail et al. Prevalence and significance of potential drug-drug interactions among cancer patients receiving chemotherapy //BMC Cancer. 2020; 20: 335. Published online 2020 Apr 19. doi: 10.1186/s12885-020-06855-9
7. O.Victorov, M.Sharayeva Concomitant Drug Use and Fatal ADR Case Report// Pharmacoepidemiology and Drug Safety, 12 : s.199-274 ( 2003), N 800/ Abstracts ISOP annual conference “ Pharmacovigilance in Clinical Practice” Marrakech, Morocco, 8-11 October, 2003
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Науковий керівник: Лизогуб Віктор Григорович, професор, Національний медичний університет імені О.О. Богомольця
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