ORAL ANTICOAGULANT PRESCRIPTION ANALYSIS FOR UTILISATION PATTERN AMONG IN-PATIENTS AT A TERTIARY CARE HOSPITAL

Objective: Selection of oral anticoagulants (OACs) in patients with thromboembolic diseases is complex and equivocal in nature, owing majorly to the non-adherence to standard clinical guidelines. Moreover, there is a scarcity of data on utilisation pattern of OACs in Indian population. Our primary objective was to analyse the prescribing pattern of OACs among in-patients with thromboembolic disorders. The secondary objective was to determine the significant predictors that affect their utilisation pattern.Methods: This prospective observational study examined the clinical data over 6 mo from in-patients on oral anticoagulation with warfarin and acenocoumarol. Patients were recruited into 2 study groups: coronary artery disease (CAD) and non-CAD to analyse the prescription pattern. Potential predictors of utilisation pattern were evaluated for significance with logistic regression analysis for CAD group.Results: Prescription analysis highlights preference of acenocoumarol (72.4%) over warfarin among 232 in-patients in the study. Lack of achievement of target international normalised ratio (INR) levels was noticed in 74.2% of the study population. 57.8% of cases belonged to CAD group (males 76.7%; mean age 59.4±13.5 y). Valvular heart disease (VHD) was the significant predictor (p =0.001) of warfarin utilisation among CAD patients while male gender, heart failure (HF) and arrhythmia were significant for acenocoumarol.Conclusion: Predominance of age<60 y and male gender was observed in the study. Acenocoumarol was preferred over warfarin in all the in-patient departments. VHD, male gender, HF and arrhythmia significantly affected the OAC utilisation

A SYSTEMATIC REVIEW OF RISK FACTORS OF ADVERSE DRUG REACTIONS IN HOSPITALIZED PATIENTS

Background: Adverse drug reactions (ADRs) pose both financial and health encumbrances for patients. Although prevalence and risk factors associated with ADRs have been published in many studies, most of them lack the statistical evidence for predictors. The aim of this study was to review the published literature to determine the risk factors in the adult and elderly population for ADRs. An electronic search of articles published in English language in databases such as Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Scopus, and Google Scholar was conducted in between January 2001 and April 2018. The search terms used were: ADRs,†drug-related problems,†risk factors,†general adult population,†elderly patients,†and hospital admission.†For inclusion in the review, studies had to include an explicit definition of what was considered an ADR and/or an explicit assessment of causality, as well as a clear description of the method used for ADR identification. Polypharmacy was the major risk factor of ADR followed by comorbidities and length of hospital stay