Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Anticoagulants

'Worrying' number of patients prescribed risky anticoagulant drug combinations

Figures released by the NHS show that more than 30,000 patients were prescribed an antiplatelet and anticoagulant without gastroprotection over a three-month period in 2018, presenting a serious risk to patients’ health.

Anticoagulants

Source: Shutterstock.com

Drug combinations involving anticoagulants are a frequent cause of medicine-relatied hospital admissions

Tens of thousands of patients are potentially being put at risk of a major bleed by being prescribed an antiplatelet without gastroprotection or a non-steroidal anti-inflammatory drug (NSAID) alongside an anticoagulant, NHS figures have shown.

The data show that, in the most recent period available for analysis (September 2018 to November 2018), there were more than 14,000 patients in England prescribed an NSAID with an anticoagulant and more than 30,000 patients prescribed an antiplatelet and anticoagulant without gastroprotection.

Both the National Institute for Health and Care Excellence and the Medicines and Healthcare products Regulatory Agency advise that special care should be taken when deciding to prescribe NSAIDs or antiplatelets with anticoagulants because of the increased risk of major bleeding.

In the same period there were 38 admissions to hospital for gastric bleeds for every 10,000 patients taking an NSAID and an anticoagulant, and 117 admissions for every 10,000 on an anticoagulant and antiplatelet without gastroprotection.

The figures — obtained by The Pharmaceutical Journal from the Medication Safety Dashboard run by the NHS Business Services Authority — come as NHS England identified anticoagulation as one of six ‘headline issues’ to be addressed by its Medicines Safety Programme, details of which were published in July 2019

Under the programme, pharmacists will be trained in shared decision making so that they can support patients with atrial fibrillation who are taking anticoagulants. Audits on anticoagulation will also form part of the Pharmacy Quality Scheme for 2020/2021, according to the community pharmacy contractual framework, which was also published in July 2019.

Eve Knights, chief executive of Anticoagulation UK described the figures as “worrying”. She said: “What is vitally missing is a patient care plan — every patient should have a care plan tailored to [them] so everyone can see they are on an [anticoagulant] — we really need to consider very carefully what we are giving them.”

Matthew Fay, a GP with a special interest in cardiology, said increasing pressure not to prescribe other analgesics, such as opioids and gabapentinoids, meant patients were being put on NSAIDs.

“GPs are feeling that there’s nowhere else to go with analgesics for patients and forget the basic rule that anticoagulants and NSAIDs are a no-go,” he said.

However, David Russell a pharmacist manager of a Well Pharmacy in Grenoside, Sheffield, who runs a warfarin-monitoring clinic, argues that it is not always simple when it comes to medicines that may potentially interact.

“[It’s about] weighing up risks and benefits. In training, you’re told you should never see aspirin and warfarin together but, in some situations, it’s less risky than someone getting a clot after a stent.

“It’s about having the background information and working out what’s appropriate for that patient — not one size fits all.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206950

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Drugs of Abuse

    Drugs of Abuse

    A concise, easy-to-read guide for healthcare professionals who encounter drug abuse.

    £38.00Buy now
  • Sport and Exercise Medicine for Pharmacists

    Sport and Exercise Medicine for Pharmacists

    All the information you need to provide patients with evidence-based advice on sports and exercise related health matters.

    £27.00Buy now
  • Adverse Drug Reactions

    Adverse Drug Reactions

    A practical guide to the drug reactions that affect particular organ systems, and the management of these reactions.

    £38.00Buy now
  • English Delftware Drug Jars

    English Delftware Drug Jars

    This beautiful book illustrates the art and history of the collection of English delftware drug jars in the Museum of the Royal Pharmaceutical Society of Great Britain.

    £54.00Buy now
  • Paediatric Drug Handling

    Paediatric Drug Handling

    Written for new pharmaceutical scientists, this book provides a background in paediatric pharmacy and a comprehensive introduction to children's medication.

    £33.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Jobs you might like

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.