Safely use blood thinners
15 million Americans are harmed each year in our hospitals. Half of these events are related to medication safety. Many people are harmed because they accidentally take their blood thinner medicine incorrectly. Warfarin is an oral anticoagulant medicine, or blood thinner, that is used to treat patients with blood clots or to prevent blood clots from forming in patients with heart arrhythmias such as atrial fibrillation. Warfarin may also be used after orthopedic surgery to prevent blood clots or in patients with artificial heart valves.
Many patients on warfarin may also be taking aspirin or other anti-platelet medications. In a retrospective cohort study published recently in Chest, Johnson, et.al found that 38% of warfarin users were also taking an antiplatelet medicine resulting in a 2.1x greater risk of major hemorrhage [adjusted odds ratio 95% CI 1.01-4.4]. There was no benefit noted in the combination users. [Johnson, SG, et.al. Outcomes Associated with Combined Antiplatelet and Anticoagulant Therapy. Chest 2008; 133: 948-954.]
Combination anticoagulation/antiplatelet therapy is indicated for select mechanical prosthetic heart valve patients. This therapy has been studied in post-acute myocardial infarction patients without benefit but the risk of hemorrhage was higher. [Circ 2002; 105;557-563] The anticoagulants have been identified as high risk medicines. Many patients are harmed each day because of their misuse.
If an adequate medication history is not taken, patients may be prescribed warfarin and continue to take aspirin. This dangerous combination puts patients at serious risk of major hemorrhage and possibly death. It is imperative that clinicians take a complete medication history at every visit since patients may see more than one doctor or other health care provider or healer and may also start new “over the counter” preparations that may impact on therapy. (e.g Patient is on warfarin and starts taking gingko for “improving memory.” Gingko has been shown in some reports to increase the risk of hemorrhage while on warfarin.)
Please discuss medication safety with your health care provider and pharmacist at every visit. Demand that your physician or nurse review all of your medications and update your personal medication list at every visit. Pay particular attention to drug interactions and prescribing directions. Be safe. Until we meet again...
Many patients on warfarin may also be taking aspirin or other anti-platelet medications. In a retrospective cohort study published recently in Chest, Johnson, et.al found that 38% of warfarin users were also taking an antiplatelet medicine resulting in a 2.1x greater risk of major hemorrhage [adjusted odds ratio 95% CI 1.01-4.4]. There was no benefit noted in the combination users. [Johnson, SG, et.al. Outcomes Associated with Combined Antiplatelet and Anticoagulant Therapy. Chest 2008; 133: 948-954.]
Combination anticoagulation/antiplatelet therapy is indicated for select mechanical prosthetic heart valve patients. This therapy has been studied in post-acute myocardial infarction patients without benefit but the risk of hemorrhage was higher. [Circ 2002; 105;557-563] The anticoagulants have been identified as high risk medicines. Many patients are harmed each day because of their misuse.
If an adequate medication history is not taken, patients may be prescribed warfarin and continue to take aspirin. This dangerous combination puts patients at serious risk of major hemorrhage and possibly death. It is imperative that clinicians take a complete medication history at every visit since patients may see more than one doctor or other health care provider or healer and may also start new “over the counter” preparations that may impact on therapy. (e.g Patient is on warfarin and starts taking gingko for “improving memory.” Gingko has been shown in some reports to increase the risk of hemorrhage while on warfarin.)
Please discuss medication safety with your health care provider and pharmacist at every visit. Demand that your physician or nurse review all of your medications and update your personal medication list at every visit. Pay particular attention to drug interactions and prescribing directions. Be safe. Until we meet again...
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