Abstract
BackgroundAnticoagulants are commonly prescribed in medical practices and could be of significant harm in the case of medication errors. We conducted a retrospective observational study to determine the frequency and consequences of the therapeutic duplication of anticoagulants (TDA). As a secondary objective, we aimed to determine the characteristics of the population in which TDA occurs.MethodsWe conducted a retrospective observational study among admitted patients who concomitantly received at least two anticoagulants from August 2017 to August 2018.ResultsA total of 107 patients with TDA are included in the research. The patients with TDA have a mean age of 73. The TDA population has a high rate of associated comorbidities with 69% of patients having arterial hypertonia, 40% with chronic kidney disease, 26% with a history of malignancy, and 20.5% with a history of stroke. More than 65% of patients were under anticoagulation before admission, mostly due to atrial fibrillation. The TDA occurred in more than 95% of cases in the first week or the last week of hospitalization. Patients had a high risk of bleeding prior to the TDA-event with about 62.5% of TDA patients having a HAS-BLED score at least 3. A total of 8 patients showed a significant Hemoglobin (Hb)-drop of at least 10 g/L within 24 h after TDA-event. Two patients had a new or worsened hematuria following TDA-event.ConclusionTDA occurred in 0.8% of patients who were under anticoagulation and in 6.7% of patients who received direct oral anticoagulants (DOACs). TDA led in about 7.4% of cases to hemoglobin-relevant bleeding. The old patients with significant comorbidities and a high HAS-BLED score were mainly affected. The female gender and presence of anemia independently predicted the occurrence of bleeding following TDA.
Highlights
Anticoagulants are commonly prescribed in medical practices and could be of significant harm in the case of medication errors
Patients who received the anticoagulants separately, no overlapping prescription [2] patients treated with the combination of heparin/ heparin analogs and vitamin-K antagonists (VKA) [3] patients receiving heparin/ heparin analogs based on a weekly schedule such as patients with hemodialysis [4] patients receiving low-dose alteplase (= < 4 mg) as a catheter locking solution [5] patients treated with the combination of VKA and direct oral anticoagulants (DOACs) during bridging from DOACs to VKA [6] patients who explicitly refused participation in research
It was suggested that anemia might contribute to the major bleeding under rivaroxaban therapy [18], our study showed a lower proportion of anemia in patients with Hb-relevant bleeding
Summary
Anticoagulants are commonly prescribed in medical practices and could be of significant harm in the case of medication errors. The studies reporting the frequency and complications of AK-related medication errors have been mostly done based on data reported to in-house or nation-wide drug safety systems [2, 3, 5,6,7,8,9,10]. As many of these errors could not be detected or have not been reported by medical staff, the studies based on them could not reliably show the incidence of errors, the affected population and the rate of consequences. For different categories of ACs, the rates of adverse complications, especially the minor and major bleeding rates, have been well studied and reported [11,12,13,14,15]
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