Risk management of QTc-prolongation in patients receiving haloperidol: an epidemiological study in a University hospital in Belgium

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• 作者：Eline Vandael ; Bert Vandenberk…
• 关键词：Haloperidol ; QTc ; prolongation ; Risk management ; Sudden cardiac death ; Torsade de Pointes
• 刊名：Pharmacy World Science
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：38
• 期：2
• 页码：310-320
• 全文大小：578 KB
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• 作者单位：Eline Vandael (1)
  Bert Vandenberk (2) (3)
  Joris Vandenberghe (4) (5)
  Isabel Spriet (1) (6)
  Rik Willems (2) (3)
  Veerle Foulon (1)
  
  1. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium
  2. Department of Cardiovascular Sciences, KU Leuven - University of Leuven, 3000, Leuven, Belgium
  3. Department of Cardiology, University Hospitals Leuven, 3000, Leuven, Belgium
  4. Department of Neurosciences, KU Leuven - University of Leuven, 3000, Leuven, Belgium
  5. Department of Psychiatry, University Hospitals Leuven, 3000, Leuven, Belgium
  6. Department of Pharmacy, University Hospitals Leuven, 3000, Leuven, Belgium
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Internal Medicine
  Pharmacy
  
• 出版者：Springer Netherlands
• ISSN：2210-7711

文摘

Background Many drugs, including haloperidol, are linked with a risk of QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death. Objective To investigate the prevalence of concomitant risk factors for QTc-prolongation in patients treated with haloperidol, and the use of safety measures to minimize this risk. Setting: University Hospitals of Leuven, Belgium. Methods A retrospective epidemiological study was performed. On 15 consecutive Mondays, all patients with a prescription for haloperidol were included. A risk score for QTc-prolongation, inspired by the pro-QTc score of Haugaa et al., was calculated based on gender, comorbidities, lab results and concomitant QTc-prolonging drugs (each factor counting for one point). Available electrocardiograms before and during the treatment of haloperidol were registered. Main outcome measure: Management of the risk of QTc-prolongation. Results Two hundred twenty-two patients were included (59.0 % men, median age 77 years) of whom 26.6 % had a risk score of ≥4 (known to significantly increase the mortality). Overall, 24.3 % received haloperidol in combination with other drugs with a known risk of Torsade de Pointes. Half of the patients had an electrocardiogram in the week before the start of haloperidol; only in one-third a follow-up electrocardiogram during haloperidol treatment was performed. Of the patients with a moderately (n = 41) or severely (n = 14) prolonged QTc-interval before haloperidol, 48.8 % and 42.9 % respectively had a follow-up electrocardiogram. In patients with a risk score ≥4, significantly more electrocardiograms were taken before starting haloperidol (p = 0.020). Conclusions Although many patients had risk factors for QTc-prolongation (including the use of other QTc-prolonging drugs) or had a prolonged QTc on a baseline electrocardiogram, follow-up safety measures were limited. Persistent efforts should be taken to develop decision support systems to manage this risk.