Characterization of oral anticoagulant prescription in patients hospitalized (Costa Rica)

Authors

  • José Miguel Chaverri Fernández Hospital Clínica Bíblica
  • Carolina Rojas León Universidad de Ciencias Médicas
  • Alexander Yeung Leu Universidad de Ciencias Médicas
  • Esteban Zavaleta Monestel Hospital Clínica Bíblica

DOI:

https://doi.org/10.51481/amc.v57i1.864

Keywords:

Oral anticoagulants, clinical pharmacy, thrombosis, pharmacovigilance

Abstract

Background: Oral anticoagulants require a strict pharmacovigilance; it is important to describe and analyze use of these drugs in order to draft guidelines, recommendations and warnings, and thus provide medical personnel with a tool for their adequate use.Methods: Inpatients that received oral anticoagulants were selected and the specific information for this analysis was collected. The guidelines of the American College of Chest Physicians, as well as those of the American and European professional associations of cardiology were used.Results: Information from 176 patients was collected. The specialists that prescribe these drugs are orthopedists (40%), internal medicine (14%), cardiologists (13%) and intensive care (11%), for the treatment of stroke thromboprophylaxis, postoperative thromboprophylaxis, treatment of pulmonary embolism and deep vein thrombosis; 84% of the patients that used these drugs did so in approved prescriptions. Bleeding related to these drugs was reported in 3.4 % of the cases.Conclusion: Most prescriptions were administered according to the guidelines, despite this there is a clear inconsistency between tests ordered and their monitoring. Most bleeding reports were associated to warfarin, yet it remains the standard treatment for this kind of patients until reversion treatments for new oral anticoagulants and suitable methods for monitoring, when required, are approved.

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References

Höchtl T, Huber K. New anticoagulants for the prevention of stroke in atrial fibrillation. Fund Clin Pharmacol. 2012;26:47-53.

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2012;33:1635-1701.

Lader E, Martin N, Cohen G, Meyer M, Reiter P, Dimova A, et al. Warfarin therapeutic monitoring: is 70% time in the therapeutic range the best we can do? J Clin Pharm Ther. 2012;37:375-377.

Kanagasabapathy P, Chowdary P, Gatt A. Alternatives to Warfarin-The Next Generation of Anticoagulants. Cardiovasc Ther. 2011;29: e80-e88.

Pérez A, Eraso LH, Merli GJ. Implications of new anticoagulants in primary practice. Int J Clin Pract. 2013;67:139-156.

Smythe MA, Fanikos J, Gulseth MP, Wittkowsky AK, Spinler SA, Dager WE, Nutescu EA. Rivaroxaban: Practical considerations for ensuring safety and efficacy. Pharmacotherapy. 2013;33:1223-45.

Walenga JM, Adiguzel C. Drug and dietary interactions of the new and emerging oral anticoagulants. Int J Clin Pract. 2010;64:956-67.

Eby, C. Novel anticoagulants and laboratory testing. Int J Lab Hematol. 2013;35:262-268.

Baglin T. The role of the laboratory in treatment with new oral anticoagulants. J Thromb Haemost. 2013;11(Suppl. 1):122-128

Sarah S. The pharmacology and therapeutic use of dabigatran etexilate. J Clin Pharmacol. 2013;53:1-13.

Peacock WF, Gearhart MM, Mills RM. Emergency management of bleeding associated with old and new oral anticoagulants. Clin Cardiol. 2012;35:730737.

Harris K, Mant J. Potential impact of new oral anticoagulants on the management of atrial fibrillation-related stroke in primary care. Int J Clin Pract. 2013;67:647-655.

Tripodi A, Palareti G. New anticoagulant drugs for treatment of venous thromboembolism and stroke prevention in atrial fibrillation. J Intern Med. 2012;271:554-565.

Verheugt FW. Advances in stroke prevention in atrial fibrillation: enhanced risk stratification combined with the newer oral anticoagulants. Clin Cardiol. 2013;36:313-322.

Turpie AGG. Rivaroxaban for the prevention and treatment of venous thromboembolism.Fund Clin Pharmacol. 2012;26:33-38.

Eikelboom, John M., Hirsh J, Frederick A. Spencer, Baglin T, and Weitz J. Antiplatelet drugs: Antithrombotic therapy and prevention of thrombosis. Chest. 2012;141:89-119.

Per Olav V. Lincoff M. Gore J. Gutterman D, Sonnenberg Coello P. Elie A. Lansberg M. Primary and secondary prevention of cardiovascular disease. Chest. 2012;141:637-668

Whitlock R. Sun J. Fremes S. Rubens F. Antithrombotic and thrombolytic therapy for valvular disease. Antithrombotic therapy and prevention of thrombosis. Chest. 2012;141: 576-600.

Lansberg M. O.Donnel M. Khatri P. Lang E. Nguyen-Huynh M. Schwartz N. Antithrombotic and thrombolytic therapy for ischemic stroke. Antithrombotic therapy and prevention of thrombosis. Chest. 2012;141:601-636.

You J. Singer D. Howard P. Lane D. Eckman M. Fang M. Hylek E. Schulman S. Hughes M. Spencer F. Manning W. Halperin J. Lip G. Antithrombotic therapy

for atrial fibrillation. Antithrombotic therapy and prevention of thrombosis. Chest. 2012;141:531-575.

Kearon C, Akl E, Comerota A, Prandoni P, Bounameaux H, Goldhaber S, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinica practice guidelines. Chest. 2012;141:419S-494S.

Douketis J, Spyropoulos A, Spencer A, Mayr M, Jaffer A, Eckman M, et al. Perioperative management of antithrombotic therapy. Antithrombotic therapy and prevention of thrombosis. Chest. 2012;141;326S-350S.

Falck-Ytter Y. Francis C. Johanson N. Curley C. Dahl E. Schulman S. Ortel T. Pauker S. Cohwell Jr C. Prevention of VTE in orthopedic surgery patients. Antithrombotic therapy and prevention of thrombosis. Chest. 2012;141:278S-325S.

Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral Anticoagulant Therapy therapy and prevention of thrombosis. Chest. 2012;141:44S-88S.

Anderson J. Halperin J. Albert N. Brindis R. Curtis L. Hochman J. Kovacs R, et al. Management of Patients with Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation. 2013;127:1916-1926.

Wann S, Curtis A, Ellenbogen K, Estes M, Ezekovitz M, Jackman W, et al. Focused Update on the Management of Patients With Atrial Fibrillation (Update on Dabigatran)."" American College of Cardiology. 2011. [Internet]. 14 Agosto. 2013. [citado 20 Diciembre 2010]. http://circ.ahajournals.org/ content/123/1/104.

Camm J. Lip G. De Caterina R. Savelieva I. Atar D. Hohnloser S. Hindricks G. Kirchhof P. Focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33:2719-2747.

Turpie AG, Kreutz R, Llau J, Norrving B, Haas S. Management consensus guidance for the use of rivaroxaban -an oral, direct factor Xa inhibitor. J Thromb Haemost. 2012;108:876-886.

Schulman S. Advantages and limitations of the new anticoagulants. J Intern Med. 2014;275:1-11.

Rose AJ, Berlowitz DR, Miller DR, Hylek EM, Ozonoff A, Zhao S, Reisman JI, Ash AS. INR targets and site-level anticoagulation control: results from the Veterans Affairs Study to Improve Anticoagulation (VARIA). J Thromb Haemost. 2012;10:590-595.

Bungard T; YakiwchuK; Foisy M; Brocklebank C. Drug interactions involving warfarin: Practice tool and practical management tips. Can Pharm J. 2011;144: 21-25.

Maddison J, Somogyi AA, Jensen BP, James HM, Gentgall M, Rolan PE. The pharmacokinetics and pharmacodynamics of single dose (R) and (S)-warfarin administered separately and together: relationship to VKORC1 genotype. J Clin Pharmacol. 2013;75:208-216.

Kazmi RS, Lwaleed BA. New anticoagulants: how to deal with treatment failure and bleeding complications. J Clin Pharmacol. 2011;72:593-603.

Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: A randomized, placebo-controlled, crossover study in healthy subjects. Circulation. 2011;124:1573-1579.

Published

2015-01-30 — Updated on 2015-01-30

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How to Cite

Characterization of oral anticoagulant prescription in patients hospitalized (Costa Rica). (2015). Acta Médica Costarricense , 57(1), 16-22. https://doi.org/10.51481/amc.v57i1.864