ORAL ANTICOAGULANT PRESCRIPTION ANALYSIS FOR UTILISATION PATTERN AMONG IN-PATIENTS AT A TERTIARY CARE HOSPITAL
DOI:
https://doi.org/10.22159/ijpps.2018v10i3.24102Keywords:
Prescribing pattern, Oral anticoagulants, International normalised ratio, Drug-drug interactionsAbstract
Objective: Selection of oral anticoagulants (OACs) in patients with thromboembolic diseases is complex and equivocal in nature, owing majorly to the non-adherence to standard clinical guidelines. Moreover, there is a scarcity of data on utilisation pattern of OACs in Indian population. Our primary objective was to analyse the prescribing pattern of OACs among in-patients with thromboembolic disorders. The secondary objective was to determine the significant predictors that affect their utilisation pattern.
Methods: This prospective observational study examined the clinical data over 6 mo from in-patients on oral anticoagulation with warfarin and acenocoumarol. Patients were recruited into 2 study groups: coronary artery disease (CAD) and non-CAD to analyse the prescription pattern. Potential predictors of utilisation pattern were evaluated for significance with logistic regression analysis for CAD group.
Results: Prescription analysis highlights preference of acenocoumarol (72.4%) over warfarin among 232 in-patients in the study. Lack of achievement of target international normalised ratio (INR) levels was noticed in 74.2% of the study population. 57.8% of cases belonged to CAD group (males 76.7%; mean age 59.4±13.5 y). Valvular heart disease (VHD) was the significant predictor (p =0.001) of warfarin utilisation among CAD patients while male gender, heart failure (HF) and arrhythmia were significant for acenocoumarol.
Conclusion: Predominance of age<60 y and male gender was observed in the study. Acenocoumarol was preferred over warfarin in all the in-patient departments. VHD, male gender, HF and arrhythmia significantly affected the OAC utilisation.
Downloads
References
Anakwue RC, Ocheni S, Madu AJ. Utilisation of oral anticoagulation in a teaching hospital in Nigeria. Ann Med Health Sci Res 2014;4:286-90.
George J, Devi P, Kamath DY, Anthony N, Kunnoor NS, Sanil SS. Patterns and determinants of cardiovascular drug utilisation in coronary care unit patients of a tertiary care hospital. J Cardiovasc Dis Res 2013;4:214-21.
Association of Physicians in India. Oral Anticoagulants: Current Indian Scenario; 2013. Available from: http://www. apiindia.org/medicine_update_2013/chap90. [Last accessed on 02 Aug 2015]
Whitworth MM, Haase K, Fike DS, Bharadwaj RM, Young RB, MacLaughlin EJ. Utilisation and prescribing patterns of direct oral anticoagulants. Int J Gen Med 2017;10:87–94.
Chedepudi PR, Mounika O, Chandrika G, Franklin A, Ramesh M, Rani V, et al. Impact of pharmacist-led anticoagulation monitoring and patient education on oral anticoagulation therapy with acenocoumarol. Asian J Pharm Clin Res 2017; 10:314-7.
Iuliano L, Matteo AD, Straface G. Management of nonvalvular atrial fibrillation: a comprehensive approach. Indian J Med Sci 2009;63:419-30.
WHO. International Classification of Diseases. Version 10; 2010. Available from: http://apps.who.int/classifications/ icd10/browse/2015/en/ [Last accessed on 05 Mar 2014]
Joshi P, Islam S, Pais P. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 2007;297:286-94.
Bounda G, Ngarambe C, Ge WH, Yu F. Assessment and evaluation efficacy of a clinical pharmacist-led inpatient warfarin knowledge education program and follow up at a Chinese tertiary referral teaching hospital. Arch Pharm Pract 2013;4:168-79.
Gomar FS, Quilis CP, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med 2016;4:256-68.
Shehab A, Elnour A, Abdulle A, Souid AK. A prospective study on the use of warfarin in the United Arab Emirates. Open Cardiovasc Med J 2012;6:72-5.
Ma SM, John J. Assess the prevalence of hypertension and knowledge regarding the prevention of stroke. Asian J Pharm Clin Res 2017;10:177-80.
Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Di Angelantonio E, et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens 2014;32:1170-7.
Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemography Soc Biol 2015;61:1-17.
Huang L, Li J, Jiang Y. Association between hypertension and deep vein thrombosis after orthopaedic surgery: a meta-analysis. Eur J Med Res 2016;21:1-7.
Lakshmi R, James E, Kirthivasan R. Study on the impact of clinical pharmacist’s interventions in the optimal use of oral anticoagulants in stroke patients.Indian J Pharm Sci 2013;75:53–9.
Woods EA, Ackman ML, Graham MM, Koshman SL, Boswell RM, Barry AR. Anticoagulant and antiplatelet prescribing patterns for patients with atrial fibrillation after the percutaneous coronary intervention. Can J Hosp Pharm 2016;69:280-5.
Nekkanti H, Mateti UV, Vilakkathala R, Rajakannan T, Mallaysamy S, Padmakumar R. Predictors of warfarin-induced bleeding in a South Indian cardiology unit. Perspect Clin Res 2012;3:22-5.
Dhanya PS, Nidheesh C, Kuriakose KM, Puthiyaveetil N. Pattern of oral anticoagulant use following prosthetic heart valve replacement: a prospective observational study. Indian J Thoracic Cardiovascular Surgery 2011;27:119-24.
Trailokya A, Hiremath JS, Sawhney JPS, Mishra YK, Kanhere V, Srinivasa R, et al. Acenocoumarol: a review of anticoagulant efficacy and safety. J Assoc Physicians India 2016;64:88-93.
Elseviers M, Andersen M, Benko R, Andersen M, Benko R, Bennie M, et al. Utilisation research in the area of cardiovascular medicines. Drug Utilisation Research: Methods and Applications, Chichester: John Wiley and sons; 2016. p. 290-3.
Trailokya A, Bahulayan A. Acenocoumarol in the geriatric population. J Clin Exp Cardiology 2016;7:1-2.
Mark L, Dani G, Vendrey R, Paragh G, Katona A. Oral anticoagulant therapy and bleeding events with vitamin k antagonists in patients with atrial fibrillation in a Hungarian county hospital. Med Sci Monit 2015;21:518–25.
Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ, et al. Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis: american college of chest physicians evidence-based clinical practice guidelines (9th Edition). Chest 2012;141(2 Suppl):e152S-e184S.
UrtÄne I, Bandere D, Ansabergs J, Stokmane AS. Role of clinical pharmacist in anticoagulation management. Med Theory Practice 2012;18:189–92.
Singh V, Gopinath K, Behzadpour A, Meera NK. Anticoagulant utilisation evaluation in a tertiary care teaching hospital: an observational prospective study in medical in patients. Indian J Pharm Practice 2015;8:61-6.
Teklay G, Shiferaw N, Legesse B, Bekele ML. Drug-drug interactions in risk of bleeding among inpatients on warfarin therapy: a prospective observational study. Thromb J 2014;20:1-8.
Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag 2015;11:1061-75.
Published
How to Cite
Issue
Section
