A Cross Sectional Interventional Study to Identify Drug Related Problem and Assess Patient Knowledge about Anti-Coagulant and Antiplatelet Agents at Tertiary Care Hospital in Dakshina Kannada

Abstract

Anticoagulants and antiplatelets are vital in treating cardiovascular diseases (CVDs) by preventing thrombus formation and embolic complications. However, they can cause adverse drug reactions (ADRs), particularly in geriatrics. Drug-drug interactions (DDIs) may lead to toxicity or reduced therapeutic effects. Patient education on risks and benefits improves adherence to treatment, impacting outcomes positively. To assess and identify DDIs and ADRs with the prescribed anticoagulant and antiplatelets and analyze the impact of education on patient knowledge on antiplatelets and anticoagulants. A cross-sectional interventional study was conducted among150 participants based on the inclusion criteria. The data was collected by interviewing the patients or from patients’ medical records and analyzed using Microsoft excel. Adverse drug reactions (ADRs) observed after administration of heparin were bleeding events in 6.89% of patients, including hematuria (3.4%) and upper gastrointestinal bleed (3.4%). Warfarin, acenocoumarol, dabigatran, and enoxaparin were associated with ADRs such as nosebleeds (12.5%), thrombocytopenia (33.3%), and abdominal pain (14.2%). Patients on aspirin, clopidogrel, and ticagrelor reported ADRs like dyspepsia (0.8%), melena (0.8%), and constipation (1.6%) which were managed with dose reduction or drug withdrawal. Additionally, the study identified eight drug-drug interactions, including clopidogrel with calcium channel blockers (moderate) and aspirin with acenocoumarol (major). Resolution included withholding interacting drugs and administering vitamin K. Post intervention patient knowledge was found to be improved. The study imparts demographic trends, comorbidities, and treatment patterns in patients receiving antiplatelet and anticoagulant therapy, explaining complex treatment regimens and low generic drug prescription rates. It highlights the need for standardized medication sourcing and comprehensive monitoring for optimized patient care. The study identified ADRs with anticoagulant and antiplatelet treatment, which were managed by adjusting doses or discontinuing drugs as needed. Patient awareness improved post-intervention notably for specific medications, with reduced uncertainty about treatment. The findings emphasize the need for vigilant management and patient education to enhance the safety and effectiveness of therapy.

Keywords

Introduction

The patients medication chart was evaluated for drug interaction involving anticoagulants and antiplatelet therapy. A total of 8 interactions were identified, in which 1 interaction each was found between clopidogrel and calcium channel blockers (moderate), aspirin and acenocoumarol (major), clopidogrel and proton pump inhibitor (major), aspirin and angiotensin receptor blockers (moderate), Inj. heparin and aspirin (moderate), Inj. heparin and vasodilators (moderate), aspirin and dabigatran (major) and between aspirin and clopidogrel (moderate). The various resolutions done were withholding the interacting drugs and administration of vitamin k. In some patients no change in drug therapy was observed. The various drug-drug interactions were asessesd using lexidrugs.

4. Knowledge of Patients regarding antiplatelets and anticoagulant therapy

Figure 1: Assessing the knowledge of the patient regarding name of the drug

Prior to the intervention or education, only 13.3% of participants were aware that they were taking antiplatelet and anticoagulant drugs, while the majority (86.6%) were not aware. However, after the study, awareness dramatically increased to 100%, with all 150 participants acknowledging that they were taking these medications. This significant shift indicates the effectiveness of the study in educating participants about their medication regimen.

Figure 2: Assessing the knowledge of patient about prescribed medicine

In Pre-study, 7.7% of respondents indicated they did not know the reason for the prescription, which decreased to 0% post-study, indicating a significant improvement in understanding. Overall, the post-study results show a substantial improvement in respondents' understanding of the reasons for prescribing the medicine, with fewer respondents indicating uncertainty and more accurately identifying conditions such as cardiac issues/chest pain and cerebrovascular accidents as reasons for the prescription

Figure 3: Evaluating patients' understanding of how medications function within their bodies.

In Pre-study, 86.8% of respondents indicated they did not know how the medicine works in the body, which decreased significantly to 4.6% post-study, indicating a remarkable improvement in understanding. The majority of respondents (9.9% pre-study, 94.7% post-study) correctly identified that the medicine prevents blood clotting, showing a substantial increase in understanding. Overall, the post-study results show a significant enhancement in respondents' understanding of how the medicine works in the body, with a vast majority correctly identifying its role in preventing blood clotting.

Figure 4: Assessing how frequently do need to consume this medication each day

In Pre-study, 66.2% of respondents indicated they did not know how many times a day the medicine needed to be taken, which decreased dramatically to 1.3% post-study, indicating a substantial improvement in understanding. Overall, the post-study results show a remarkable enhancement in respondents' understanding of the frequency of taking the medicine, with a vast majority correctly identifying that it needs to be taken once a day. There was also a significant decrease in the percentage of respondents indicating uncertainty regarding the dosing frequency.

150 participants were surveyed to assess their knowledge about antiplatelets and anticoagulants.

The assessment consisted of 15 questions where based on the scoring system 22(14.6%) demonstrated good knowledge about antiplatelets and anticoagulants while 128(85.3%) lacked it; subsequently, the participants with less knowledge where divided into two groups , with 64(50%) in the first and 64 (50%)in the second , the latter of which received an intervention and former was kept as control.

After the intervention, the case group showed a marked improvement in knowledge about how the medicine works, the importance of adhering to prescribed dosages, and the necessity of taking the medication at the same time each day. They also gained a better grasp of the consequences of missing doses, including the risks of worsening their condition, and the inappropriateness of stopping the medication early once feeling better. Additionally, their awareness increased regarding potential interactions with other drugs, alcohol, and supplements. The case group became more adept at identifying side effects and knowing the correct steps to take if too much medication is accidentally consumed. In contrast, the control group’s knowledge remained relatively unchanged, highlighting the effectiveness of the intervention in improving medication- related knowledge. In this data, p-value is less than 0.00001 across various questions indicate that the intervention effectively improved the case group's understanding of their medication compared to the control group. p-value suggests that the differences observed in the case group compared to the control group are highly statistically significant. It indicates a strong likelihood that the intervention caused the changes in knowledge.

DISCUSSION

This study indicates a significant incidence of ADRs among patients receiving anticoagulant and antiplatelet therapy. Among the subjects, Heparin administration resulted in bleeding events in 6.89% of patients, bleeding events were most commonly observed ADR, with variations in the specific types of bleeding reported, such as gastrointestinal bleeds(possible) and nosebleeds(possible). Management strategies for ADRs also aligned, with dose adjustments and drug discontinuation being common approaches. This is similar to the study carried out by Vijayakumar T M et al. in which bleeding events were the most commonly observed ADRs [2].

In the present study out of 150 cases 9 ADRs were found in patients taking antiplatelets, out of which 6 were associated with aspirin, like aspirin induced dyspepsia(possible), melena (probable), constipation(possible) hematuria(probable) ,2 were associated with clopidogrel like clopidogrel induced diarrhea(possible) and rash(possible) and 1 with ticagrelor like ticagrelor induced dyspnea(possible). This is similar to the study carried out by Reddy R P et al, in which bleeding events were the most commonly observed ADRs [1].

In this study, out of 150 patients 8 interactions were identified, highlighting the complexity of managing multiple medications in patients with CVDs. On analysis common interaction was seen between aspirin and clopidogrel which was linked to an increased risk of bleeding followed by other combinations such as clopidogrel with calcium channel blockers and aspirin with acenocoumarol. These interactions pose risks of either increasing toxicity or reducing therapeutic efficacy, underscoring the importance of vigilant monitoring and medication reconciliation, this is similar to the study carried out by Reddy R P et al., Resolutions included withholding interacting drugs and administering vitamin K [1].

This study carried out the intervention which focused on patient education and yielded promising results in improving medication knowledge and adherence. During pre-intervention, there was a lack of awareness among patients regarding their medications, whereas during post-intervention, there was a notable improvement in understanding specific medications, dosing regimens, and reasons for prescription. This is similar to the study carried out by Alajami HN et al., in which there was a significant improvement in medication knowledge and adherence post-study regarding their medication [4].

CONCLUSION

The study focused on adverse effects, drug interactions, and patient awareness related to anticoagulant and antiplatelet therapies. It observed significant occurrences of bleeding among patients receiving anticoagulants, stressing the need for rigorous monitoring and management strategies. Identified drug interactions necessitated interventions such as discontinuing interacting drugs to mitigate risks. Patient awareness regarding medications, including Dabigatran, Warfarin, and Enoxaparin, notably improved following the study, indicating enhanced understanding of dosing and potential side effects. Awareness regarding antiplatelet drugs also increased, with fewer patients uncertain about their prescriptions and better grasp of medication dosing schedules. The study highlighted the effectiveness of patient education in improving medication management practices, emphasizing the importance of informed patient involvement to optimize safety and treatment outcomes in anticoagulant and antiplatelet therapies.

ACKNOWLEDGEMENTS

I am thankful to Research guide, Principal and Management of Srinivas college of Pharmacy, Mangalore for providing all the necessary facilities to carry out this research work.

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