A Cross-Sectional Study to Assess Prescription Pattern and Evaluate Monitoring Parameters of Anticoagulant and Antiplatelet Agents at Tertiary Care Hospital in Dakshina Kannada

Antiplatelet are the root for prevention of arterial thrombosis, whereas anticoagulants are effective for venous thrombosis. The antiplatelet prevents the clot formation by inhibiting the thromboxane formation, whereas anticoagulants target clotting factors that are crucial to the blood clotting process. Antiplatelet and anticoagulants deviates from general principle of specificity. Complex associations include chronic comorbidities, disease chronicity and ageing of population ^[1]. Potentially inappropriate medications (PIM) may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions, negative health outcomes, increased risk of morbidity and mortality, and increased health care costs ^[2]. Optimizing therapy and managing bleeding risks in antiplatelet and anticoagulant treatments are crucial. Monitoring platelet count before and after initiating therapy is essential for preventing bleeding. Laboratory tests like PT and aPTT are used for monitoring. The study assesses prescription patterns using WHO indicators and evaluates monitoring parameters pre- and post- therapy ^[2]_.

OBJECTIVES

• Assessment of prescription patterns including the use of WHO (World Health Organization) prescribing indicators
• Evaluation of monitoring parameters before and after anticoagulant and antiplatelet therapy

METHODOLOGY

Study Site: Srinivas Institute of Medical Science & Research Centre, Mukka, Mangalore

Study Type: A cross-sectional interventional study

Study Duration: 2 months

Sample Size: 150

Inclusion Criteria:

• Patients of age ranging from 18 to 90 years, belonging to both genders.
• Inpatients with or without comorbid conditions receiving antiplatelet or anticoagulant drugs

Exclusion Criteria:

• Subjects who are unable to communicate such as severely ill patients, unconscious patients, and psychiatric patients
• Subjects who are not willing to participate

Methodology:

Patients are selected based on specific inclusion criteria and subjects signing consent forms prior to data collection. The data is collected through direct interviews with patients or from patient medical records.

RESULT

Prescribing pattern of antiplatelet and anticoagulants in the patients

Table 1 Showed that among 45 patients, the most commonly prescribed anticoagulant was Heparin (55.5%, followed by Enoxaparin (11.11%), Warfarin (6.66%), Dabigatran (6.66%), and Acenocoumarol (2.22%). Combination therapies were also observed, with various combinations such as Warfarin-Heparin, Enoxaparin-Warfarin, and others, each representing 2.22% of the patients. Additionally, a small percentage of patients (2.22%) were prescribed a combination of three anticoagulants, specifically Dabigatran-Enoxaparin-Warfarin.

Table 1: Drug utilization of anticoagulants in the study population

Table 2 Presents the Among 141 patients, the most commonly prescribed antiplatelet agent was Aspirin, accounting for 61.70% of the cases. Clopidogrel was prescribed in 4.96% of the patients. Combination therapies were also observed, with 24.82% of patients receiving a combination of Aspirin and Clopidogrel, 2.12% receiving Aspirin and Ticagrelor, and 6.38% receiving both Aspirin and Clopidogrel concurrently.

Table 2: Drug utilization of antiplatelets in the study population

Table 3 Presents the Among the patients, the majority were prescribed a single antiplatelet drug (APD) with Aspirin being the most common (87 patients) followed by Clopidogrel (7 patients). Additionally, a small percentage (6.38%) of patients received a combination therapy consisting of both Aspirin and Clopidogrel concurrently.

Table3: Types of the combination given to the patient

Table 4 The results found that patients receive an average of 7.73 drugs per prescription, indicating complex treatment regimens. Only 12.2% of drugs are prescribed generically, potentially hindering cost-saving opportunities. Antiplatelet drugs are prescribed in 91.8% of encounters, possibly reflecting a high prevalence of cardiovascular conditions. Anticoagulant drugs are prescribed in 30.6% of encounters, with 26% involving injections, suggesting immediate therapy needs for some patients. The drugs are sourced from the hospital formulary, ensuring standardized practices. Overall, the assessment sheds light on prescription patterns at the tertiary care hospital, aiding potential optimization for effective patient care.

Table 4: Assessment of including the use of WHO prescribing pattern (World Health Organization) prescribing indicators:

Laboratory parameters monitored among study population

Lab parameters used to monitor anticoagulant therapy among the study population (Hemoglobin, Coagulation parameters (PT/INR/PTT), Doppler)

Table 5 In the present study, laboratory parameters like Hb, coagulation parameters and doppler were evaluated. Among 150 patients, Hb levels were checked for 141 patients. The coagulation parameters like PT, INR and PTT were checked in 123 patients and 56 patients were not checked. Doppler was performed in 38 patients. However, in many of these patients, radiological diagnostic evaluations like angiography, computerized tomography (CT) scan were carried out in order to detect the presence of clots/thrombus formation.

Table 5: Laboratory parameters monitored among study population

PT: Prothrombin Time PTT: Partial Thromboplastin Time INR: International Normalized Ratio

INR value distribution with different interval for the patients who were on warfarin therapy

In our study 150 patients were on antiplatelet and anticoagulant therapy. A total of 104 INR values were recorded before the treatment and 80 INRs were recorded after the treatment. They were divided into different categories to show how INR values were distributed. Before treatment INR values for ?2, and 2-3 were 98(65.33%), 6(4%) and 46(30.66%) respectively. After the treatment, INR values were recorded in 46 patients, in which 77(51.33%), 3(2%) and 70(46.66%) of the INR values were ?2 and 2-3 range respectively. INR level were not assessed in 46 patients prior to treatment and in 70 patients post-treatment.

Table 6 Presents the values for patients on heparin, both with and without clotting time assessments. Among those assessed, 109 patients fell within one PTT interval, and 41 within another. Conversely, among those not assessed, 32 patients were within one interval, and 118 within another. Additionally, Hb% levels were measured for 148 patients with assessments and 2 without, while platelet counts were available for 134 with assessments and 16 without. Doppler assessments were conducted for 13 patients with assessments and 137 without.