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OpenSAFELY: impact of national guidance on switching anticoagulant therapy during COVID-19 pandemic
Open Heart Pub Date : 2021-11-01 , DOI: 10.1136/openhrt-2021-001784
, Helen J Curtis 1 , Brian MacKenna 1 , Alex J Walker 1 , Richard Croker 1 , Amir Mehrkar 1 , Caroline Morton 1 , Seb Bacon 1 , George Hickman 1 , Peter Inglesby 1 , Chris Bates 2 , David Evans 1 , Tom Ward 1 , Jonathan Cockburn 2 , Simon Davy 1 , Krishnan Bhaskaran 3 , Anna Schultze 3 , Christopher T Rentsch 3 , Elizabeth Williamson 4 , William Hulme 1 , Laurie Tomlinson 3 , Rohini Mathur 3 , Henry Drysdale 1 , Rosalind M Eggo 5 , Angel Yun Wong 3 , Harriet Forbes 6 , John Parry 2 , Frank Hester 2 , Sam Harper 2 , Ian Douglas 3 , Liam Smeeth 3 , Ben Goldacre 7
Affiliation  

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. Data are available in a public, open access repository.

中文翻译:

OpenSAFELY:国家指南对 COVID-19 大流行期间更换抗凝治疗的影响

背景 在 COVID-19 大流行早期,英国国家医疗服务体系 (NHS) 建议使用华法林抗凝的适当患者应改用直接作用口服抗凝剂 (DOAC),从而减少血液检测的频率。随后,针对患者在更换药物和相关监测后不恰当地联合使用两种抗凝剂的情况发布了国家安全警报。目的 描述哪些人从华法林转为 DOAC;识别抗凝剂联合处方可能不安全的情况;并评估在大流行期间异常凝血结果是否变得更加频繁。方法 经英国 NHS 批准,我们利用英国 2400 万 NHS 患者的常规临床数据进行了一项队列研究。结果 2020 年 3 月至 5 月期间,164 000 名华法林患者中有 20 000 名 (12.2%) 转用 DOAC,最常见的是艾多沙班和阿哌沙班。与转换相关的因素包括:年龄较大、最近的肾功能测试、最近记录的 INR 测试数量较多、心房颤动诊断和护理院居住情况。华法林和 DOAC 联合处方数量急剧增加,从通常每月 50-100 例增加到 2020 年 4 月的 246 例,占所有接受 DOAC 或华法林患者的 0.06%。国际标准化比值 (INR) 检测下降 14%,至每月每 1000 名华法林患者接受检测 506.8 名患者。我们观察到 4 月份 INR 升高 (n=470) 与 1 月份 (n=420) 相比略有增加。结论 在英格兰 COVID-19 大流行之初,根据国家指导,观察到抗凝药物从华法林转向 DOAC 的情况有所增加。在此期间,有一小部分人同时服用华法林和 DOAC。尽管国家对此问题发出了安全警报,但并未发现 INR 检测结果普遍升高。初级保健对 COVID-19 大流行期间患者护理的变化做出了迅速反应。数据可在公共、开放访问存储库中获取。
更新日期:2021-11-17
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