OpenSAFELY Collaborative; Curtis, Helen J; MacKenna, Brian; Walker, Alex J; Croker, Richard; Mehrkar, Amir; Morton, Caroline; Bacon, Seb; Hickman, George; Inglesby, Peter; +22 more... Bates, Chris; Evans, David; Ward, Tom; Cockburn, Jonathan; Davy, Simon; Bhaskaran, Krishnan; Schultze, Anna; Rentsch, Christopher T; Williamson, Elizabeth; Hulme, William; Tomlinson, Laurie; Mathur, Rohini; Drysdale, Henry; Eggo, Rosalind M; Wong, Angel Yun; Forbes, Harriet; Parry, John; Hester, Frank; Harper, Sam; Douglas, Ian; Smeeth, Liam; Goldacre, Ben; The OpenSAFELY Collaborative; (2021) OpenSAFELY: impact of national guidance on switching anticoagulant therapy during COVID-19 pandemic. Open heart, 8 (2). e001784-e001784. ISSN 2053-3624 DOI: https://doi.org/10.1136/openhrt-2021-001784
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Abstract
BACKGROUND: Early in the COVID-19 pandemic, the National Health Service (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 coprescribed two anticoagulants following a medication change and associated monitoring. OBJECTIVE: To describe which people were switched from warfarin to DOACs; identify potentially unsafe coprescribing of anticoagulants; and assess whether abnormal clotting results have become more frequent during the pandemic. METHODS: With the approval of NHS England, we conducted a cohort study using routine clinical data from 24 million NHS patients in England. RESULTS: 20 000 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 coprescribing 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. International normalised ratio (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). CONCLUSIONS: Increased 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 coprescribed 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.
Item Type | Article |
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Faculty and Department |
Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology Faculty of Epidemiology and Population Health > Dept of Medical Statistics Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology Academic Services & Administration > Directorate |
Research Centre |
Covid-19 Research EHR Research Group |
PubMed ID | 34785588 |
Elements ID | 167319 |