Anticoagulation Safety

Excerpt

One class of drugs that has been implicated in serious adverse drug reactions for many decades is oral anticoagulants, especially warfarin. There are countless case reports indicating the use of oral anticoagulants is more likely to require hospital admission, and prolonged hospital stays from adverse events such as bleeding.

Oral anticoagulants have been classified as high alert medications according to the Institute of Safe Medication Practices (ISMP) because they have the potential for harm when used clinically. Many reports have appeared on the risk of bleeding when the anticoagulants are used concurrently with other similar agents (antiplatelet drugs), when the drug treatment is duplicated, in the presence of dosing errors, when there is accidental discontinuation of treatment and when there are problems with monitoring.

Unlike warfarin, the newer oral anticoagulants do not have a long track record in clinical medicine and hence, it is too soon to claim that they are safer. In any case, proactive measures and targeted education should be encouraged to prevent adverse effects associated with the newer anticoagulants. More importantly, the Joint Commission has designated cautious use of an oral anticoagulant as part of the National Patient Safety Goals (NQF).