Oral Anticoagulant Prescription Analysis for Utilisation Pattern Among in-Patients at a Tertiary Care Hospital

Abstract

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.