West Virginia University Hospitals, Department of Pharmacy, 1 Medical Center Drive, Morgantown, WV 26505, USA.
University of Kentucky Chandler Medical Center, Department of Pharmacy, 800 Rose Street, Lexington, KY 40536, USA.
Am J Emerg Med. 2021 Sep;47:90-94. doi: 10.1016/j.ajem.2021.03.043. Epub 2021 Mar 15.
BACKGROUND & PURPOSE: Alteplase is the standard of care for early pharmacologic thrombolysis after acute ischemic stroke (AIS). Alteplase is also considered a high-alert medication and is fraught with potential for error. We sought to describe the difference in medication error rates in in patients receiving alteplase for acute ischemic stroke from regional hospitals compared to patients receiving alteplase at the Comprehensive Stroke Center.
This was a retrospective cohort comparison of patients who were greater than 18 years old that received intravenous alteplase for the treatment of AIS from June 2015 to June 2018. Several institution specific databases were utilized to obtain pertinent data. A standardized taxonomy was utilized to classify medication errors. Patients were excluded if they received any fibrinolytic other than alteplase or if alteplase was used for a non-stroke indication. Two cohorts (from regional hospitals or the Comprehensive Stroke Center (CSC)) were compared.
A total of 676 patients received alteplase during the study period (34% from the CSC and 66% from regional hospitals). There were 133 (19.8%) errors identified. Ten errors (1.6%) occurred at the CSC and 123 (18.2%) errors occurred at regional hospitals. More patients who had an error with alteplase administration (12.7%) experienced a hemorrhagic conversion compared to those with no error in administration (7.2%, p= 0.04).
The error rate of alteplase infusion for ischemic stroke is high, particularly in patients from referring centers. Errors may be associated with adverse events. Further education and administration safeguards should be implemented to decrease the risk of medication errors.
阿替普酶是急性缺血性脑卒中（AIS）早期药物溶栓的标准治疗方法。阿替普酶也被认为是一种高警示药物，存在潜在的用药错误风险。我们旨在描述与在综合卒中中心接受阿替普酶治疗的患者相比，在区域医院接受阿替普酶治疗的急性缺血性脑卒中患者的用药错误率差异。
这是一项回顾性队列比较研究，纳入 2015 年 6 月至 2018 年 6 月期间大于 18 岁、接受静脉内阿替普酶治疗 AIS 的患者。使用几个机构特定的数据库获取相关数据。使用标准化分类法对用药错误进行分类。如果患者接受了除阿替普酶以外的任何溶栓药物，或者阿替普酶用于非卒中适应证，则将其排除。比较两个队列（来自区域医院或综合卒中中心（CSC））。
研究期间共有 676 例患者接受了阿替普酶治疗（34%来自 CSC，66%来自区域医院）。共发现 133 例（19.8%）错误。10 例（1.6%）错误发生在 CSC，123 例（18.2%）错误发生在区域医院。与未发生阿替普酶给药错误的患者（7.2%）相比，发生阿替普酶给药错误的患者（12.7%）更可能发生出血性转化（p=0.04）。
阿替普酶治疗缺血性脑卒中的输注错误率较高，尤其是在来自转诊中心的患者中。错误可能与不良事件有关。应实施进一步的教育和给药安全措施，以降低用药错误的风险。
