Back to Search
Start Over
Preventability of serious thromboembolic and bleeding events related to the use of oral anticoagulants: a prospective study
- Source :
- British Journal of Clinical Pharmacology. 84:1544-1556
- Publication Year :
- 2018
- Publisher :
- Wiley, 2018.
-
Abstract
- Aims To determine the preventability of serious adverse drug reactions (ADRs) related to the use of direct oral anticoagulants (DOACs), and to explore contributing factors to preventable ADRs. Results were compared with vitamin K antagonists (VKAs). Methods We conducted a prospective observational study in the emergency departments of two teaching hospitals from July 2015 to January 2016. Patients admitted with a thrombotic or bleeding event while under DOAC or VKA were included. Four independent reviewers assessed causality, seriousness and preventability of ADRs using pilot-tested scales. For cases of serious and potentially preventable ADRs, we performed semi-structured interviews with general practitioners to identify contributing factors to ADRs. The primary outcome was the proportion of serious ADRs that were potentially preventable. Results The analysis included 46 DOAC and 43 VKA patients (median age 79 years). Gastrointestinal (n = 34) and intracranial (n = 16) bleedings were the most frequent ADRs. Results were that 53% of DOAC- and 61% of VKA-related serious ADRs were deemed potentially preventable. Prescribing issues and inadequate monitoring were frequent for DOAC and VKA respectively. We identified many causes of preventable ADRs that applied to all oral anticoagulants, such as pharmacodynamic drug interactions and lack of communication. Conclusions More than half of serious ADRs were potentially preventable for both DOACs and VKAs. Interventions focusing on prescribing, patient education and continuity of care should help improve the use of DOACs in practice.
- Subjects :
- Pharmacology
medicine.medical_specialty
business.industry
Psychological intervention
030204 cardiovascular system & hematology
03 medical and health sciences
Patient safety
PHARMACODYNAMIC DRUG INTERACTIONS
0302 clinical medicine
Primary outcome
Medicine
Pharmacology (medical)
Observational study
030212 general & internal medicine
Drug reaction
Prospective cohort study
business
Intensive care medicine
Patient education
Subjects
Details
- ISSN :
- 03065251
- Volume :
- 84
- Database :
- OpenAIRE
- Journal :
- British Journal of Clinical Pharmacology
- Accession number :
- edsair.doi...........7036bd39a8bbe0a330d0e49ee832678d