Document Type : Original Articles

Authors

Department of Pharmacy, Oxbridge college of pharmacy, affiliated to Rajiv Gandhi University of health science, Bangalore, Karnataka, India

Abstract

Background: drug utilization studies are necessary to evaluate the rational use and associated risks of anticoagulants. This study aimed to identify drug utilization pattern and possible drug interactions with the use of anticoagulants in a tertiary care hospital in Bangalore.
 
Methods: This prospective, observational study was conducted on 100 patients and anticoagulants utilization was assessed from Medicine ward of Bannerghatta Apollo hospital in Bangalore, India, during six months.
 
Results: The most common indication for anticoagulants administration was ischemic heart disease (IHD) + acute coronary syndrome (ACS) with 47% and IHD alone with 22%. Most of the patients received single drug therapy, and parenteral drugs were more preferred than oral ones (91% vs. 6%). Among the medications, heparin (49%) followed by enoxaparin (29%) and fondaparinux (13%) were the most commonly prescribed drugs. Regarding laboratory tests, 29% of the patients were evaluated for the international normalized ratio (INR) and prothrombin time(PT). The finding showed that anticoagulants might interact with corticosteroids, some antibiotics such as piperacillin, azithromycin or other drugs such as tirofiban and losartan.
 
Conclusion: Anticoagulant drug utilization pattern followed very commonly American College of Clinical Pharmacy (ACCP) guidelines. The inappropriate utilization patterns of anticoagulants may compromise the patient’s  safety.

Keywords

1.Prajwal P, Rai M, Gopalakrishna H, Kateel R. An exploratory study on the drug utilization pattern in glaucoma patients at a tertiary care hospital. Journal of Applied Pharmaceutical Science.2013;3(10):151.
2.Wettermark B, Vlahović‐Palčevski V, Lee D, Bergman U. Studies of Drug Utilization. Pharmacoepidemiology. 2019:373-410.
3.Mandernach MW, Beyth RJ, Rajasekhar A. Apixaban for the prophylaxis and treatment of deep veinthrombosis and pulmonary embolism: an evidence-based review. Therapeutics and clinical risk management. 2015;11:1273.
4.Spencer FA, Gore JM, Lessard D, Douketis JD, Emery C, Goldberg RJ. Patient outcomes after deep vein thrombosis and pulmonary embolism: the Worcester Venous Thromboembolism Study. Archives of internal medicine. 2008;168(4):425-430.
5.Naqvi SEH, Haseen MA, Beg MH, Ali E, Khan T. Deep vein thrombosis: An experience of 25 years from north India. Indian Journal of Vascular and Endovascular Surgery. 2016;3(1):2.
6.Zehnder JL. Drugs used in disorders of coagulation. Basic and clinical pharmacology. 2018;11:587-599.
7.Alquwaizani M, Buckley L, Adams C, Fanikos J. Anticoagulants: a review of the pharmacology, dosing, and complications. Current emergency and hospital medicine reports. 2013;1(2):83-97.
8.Nutescu E, Chuatrisorn I, Hellenbart E. Drug and dietary interactions of warfarin and novel oral anticoagulants:an update. Journal of thrombosis and thrombolysis. 2011;31(3):326-343.
9.Walenga J, Adiguzel C. Drug and dietary interactions of the new and emerging oral anticoagulants.International journal of clinical practice. 2010;64(7):956-967.
10.Maly J, Dvorackova S, Zimcikova E, et al. Patterns in anticoagulant utilization in the Czech Republic during 2007–2017. Journal of thrombosis and thrombolysis. 2019;47(2):305-311.
11.Bista D, Chalmers L, Peterson GM, Bereznicki LR. Anticoagulant use in patients with nonvalvular atrial fibrillation: has prescribing improved? Clinical and Applied Thrombosis/Hemostasis. 2017;23(6):573-578.
12.Wettermark B, Elseviers M, Almarsdóttir AB, et al. Introduction to drug utilization research. Drug utilization research: methods and applications. 2016:1-12.
13.Arland AJ, Selvan KM, Sundar RS, Gopala G. Study on drug utilization of anti-platelets and anti-coagulants in patients with coronary artery disease. 2019.
14.Alzubaidi N, Sharma M, Abdulmalik W, Habib A, Alhalmi A. Drug Utilization Study and Adverse Drug Reaction Reporting among Patients Using Anticoagulants in a Tertiary Care Teaching Hospital. Journal of Drug Delivery and Therapeutics. 2019;9(3-s):181-185.
15.Namazi S, Karimzadeh I. Drug utilization evaluation of unfractionated heparin in a cardiac care unit in Iran J Pharm Res. 2011;4(5):1470-1472.
16.Singh V, Gopinath K, Behzadpour A, Meera NK. Anticoagulant utilization evaluation in a Tertiary Care Teaching Hospital: An observational prospective study in medical in patients. Indian Journal of Pharmacy Practice. 2015;8(2):61.
17.Anakwue R, Ocheni S, Madu A. Utilization of oral anticoagulation in a teaching hospital in Nigeria. Annals of medical and health sciences research. 2014;4(3):286-290.
18.Mengistu G, Lemma B, Molla M. Utilization patterns of anticoagulants at medical ward of hiwot fana Specialized university hospital, harar, Ethiopia. Journal of Basic and Clinical Pharmacy. 2017;8(4).
19.Alam S, Baqir S, Naqvi S, Ahmed M. Drug utilization and economic impact of anticoagulants in unstable angina/non-st elevation myocardial infarction in Karachi. International Journal of Pharmacy and Pharmaceutical Sciences. 2015;7(3):183-185.
20.Silva VM, Rezende DC, Garcia ES, Cavalheiro C, Strunz CC. Effect of anticoagulant adjustment on prothrombin time test using two different PT reagents in patients with elevated hematocrit. Practical laboratory medicine. 2020;22:e00177.