R.Ph.s can help patients use anticoagulants safely

October 9, 2006

On behalf of the Senior Outpatient Medication Safety (SOS Rx) Coalition, the National Consumers League (NCL) recently commissioned Harris Interactive to conduct three surveys, one each of patients taking oral anticoagulants, their caregivers, and physicians who frequently prescribe these medications. The survey was made possible by an unrestricted educational grant from AstraZeneca.

According to data gathered from the survey, the four million Americans taking prescription anticoagulants need more help in managing their treatment. "The results are disturbing," said Linda Golodner, president of NCL. Ann Wittkowsky, Pharm.D., clinical professor of pharmacy at the University of Washington School of Pharmacy in Seattle and director of anticoagulation services at the University of Washington Medical Center, agreed.

"The key findings of these surveys suggested an abysmal knowledge of the purpose of anticoagulation therapy and the need for International Normalized Ratio [INR]/prothrombin time [PT] monitoring, inability to recognize the signs and symptoms of bleeding and thrombosis, and a poor understanding of potential drug interactions with anticoagulants," Wittkowsky said.

Although 93% of respondents reported experiencing an adverse reaction to their anticoagulant, 51% said that they did not alter their behavior. Among those who did experience adverse effects, 51% did not inform their provider. Many patients are left to manage their anticoagulant treatment on their own: 31% of respondents said their healthcare provider has not asked if they are having problems with their medication, and 33% said they find it difficult to contact their provider by phone.

Despite the importance of regular blood testing, 21% of survey respondents said they were uncertain what their PT or INR number should be; 28% said they did not know the results of their last blood test, even though they do know what their PT or INR number should be.

Healthcare providers can do a better job to help patients take anticoagulants safely. According to the survey results, 21% of patients said their healthcare provider failed to instruct them about special dietary considerations, 19% said their provider did not explain about possible interactions with dietary supplements and other medications, 17% said that their provider did not caution them about possible side effects, and 15% said their provider did not indicate symptoms to watch for and when to seek further treatment.

Luckily, pharmacists can play an important role in educating patients and their caregivers about optimal anticoagulant use. "Pharmacists can play a critical role at various points of care," Wittkowsky said. "For example, the dispensing pharmacist can explain such basics as the purpose and expected duration of therapy, the need for routine INR monitoring, the recognition of the signs and symptoms of both thrombosis and bleeding, and the possibility of interactions with diet, other medications, and dietary supplements." She explained that the NCL campaign is prompting patients to ask about these things, and that it is also prompting healthcare professionals to initiate the conversation.

"Continuous patient education is perhaps even more important," Wittkowsky said. "That's where anticoagulation clinics come in. These are well known to improve outcomes in patients taking blood thinners, and the most successful clinics, as described in the literature, are run by pharmacists."

NCL has created a Web site, http:// http://www.mybloodthinner.org/. It features tools for both R.Ph.s and patients. Wittkowsky said the University of Washington Medical Center Anticoagulation Services has its own Web site, http:// http://www.uwmcacc.org/, which features a warfarin-education brochure in five different languages, in addition to other patient education materials.

Golodner concluded that "this research should serve as a clarion call to patients to make sure that they get the care and answers they need from their healthcare providers, including pharmacists."