| Autor: |
Tom Ward, Richard Croker, Evans Sjw., Rosalind M Eggo, Seb Bacon, John Parry, Kevin Wing, Henry Drysdale, Rohini Mathur, Simon Davy, Liam Smeeth, Anna Schultze, Frank Hester, Brian MacKenna, Amir Mehrkar, Chris Bates, Wong Ays., Laurie A. Tomlinson, Christopher T Rentsch, William J Hulme, Alex J Walker, Caroline E Morton, Jonathan Cockburn, David M. Evans, Krishnan Bhaskaran, Sam Harper, Helen Mcdonald, Ben Goldacre, Elizabeth A. Williamson, Helen J Curtis, Peter Inglesby, George Hickman, Ian J. Douglas, Harriet Forbes |
| Jazyk: |
angličtina |
| Rok vydání: |
2020 |
| Předmět: |
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| Zdroj: |
MedRxiv |
| Popis: |
BackgroundEarly in the COVID-19 pandemic the NHS recommended that appropriate patients anticoagulated with warfarin should be switched to direct acting oral anticoagulants (DOACs), requiring less frequent blood testing. Subsequently, a national safety alert was issued regarding patients being inappropriately co-prescribed two anticoagulants following a medication change, and associated monitoring.ObjectiveTo describe which people were switched from warfarin to DOACs; identify potentially unsafe co-prescribing of anticoagulants; and assess whether abnormal clotting results have become more frequent during the pandemic.MethodsWorking on behalf of NHS England we conducted a population cohort based study using routine clinical data from >17 million adults in England.Results20,000 of 164,000 warfarin patients (12.2%) switched to DOACs between March and May 2020, most commonly to edoxaban and apixaban. Factors associated with switching included: older age, recent renal function test, higher number of recent INR tests recorded, atrial fibrillation diagnosis and care home residency. There was a sharp rise in co-prescribing of warfarin and DOACs from typically 50-100 per month to 246 in April 2020, 0.06% of all people receiving a DOAC or warfarin. INR testing fell by 14% to 506.8 patients tested per 1000 warfarin patients each month. We observed a very small increase in elevated INRs (n=470) during April compared with January (n=420).ConclusionsIncreased switching of anticoagulants from warfarin to DOACs was observed at the outset of the COVID-19 pandemic in England following national guidance. There was a small but substantial number of people co-prescribed warfarin and DOACs during this period. Despite a national safety alert on the issue, a widespread rise in elevated INR test results was not found. Primary care has responded rapidly to changes in patient care during the COVID-19 pandemic. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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