Pharmacists Key to Whether Patients Take Blood Thinners
In study, almost 30 percent of people with atrial fibrillation didn't use Pradaxa as instructed
TUESDAY, April 14, 2015 (HealthDay News) -- Millions of older Americans are prescribed a blood thinner to help reduce the stroke risks associated with a dangerous irregular heart beat known as atrial fibrillation.
A new study finds that even though a large percentage fail to take the potentially life-saving medications as prescribed, the intervention of their local pharmacist might help.
In the study, a team led by Dr. Mintu Turakhia, an assistant professor of medicine at Stanford University, in Palo Alto, Calif., looked at the use of the blood thinner Pradaxa (dabigatran) by Veterans Administration outpatients who were prescribed the drug between 2010 and 2012.
Pradaxa belongs to a new class of twice-daily oral blood thinners, and it is often prescribed for atrial fibrillation (nicknamed "a-fib").
"The new oral anticoagulants, such as dabigatran, represent the biggest medical change in the delivery of care for a-fib patients," Turakhia explained in a university news release.
"Before, the only option we had for patients was warfarin, which is cumbersome and requires blood testing once or more per month," he noted.
The new study found that of the almost 5,400 patients who got a prescription for Pradaxa, about 28 percent failed to take the drug as instructed.
"This is important because even missing a few doses can lead to acute events such as stroke. How well you take the new drugs largely determines your treatment benefit," Turakhia explained.
However, patients whose prescriptions were filled by VA pharmacists who also educated them about the drug, and then monitored them on a regular basis, were 80 percent more likely to take the drug correctly and without missing doses than those who didn't receive such assistance, the researchers found.
The study authors pointed out that newer blood thinners such as Pradaxa come in fixed doses and patients who take them don't need to have regular blood tests -- so many health experts have assumed that patients wouldn't need to be monitored.
However, this study shows that monitoring and support from pharmacists significantly boosts proper use of this class of blood thinners.
One expert agreed.
Newer blood thinners like Pradaxa haven't required the blood level checks of older drugs like warfarin, and "this has been used as a selling point" for the drugs, said Dr. Erik Altman, chief of electrophysiology at North Shore-LIJ's Southside Hospital in Bay Shore, N.Y.
However, "in certain patients it has had a negative effect, since poorer drug adherence has been noted," he added.
So, "it is necessary to do more than just prescribe the drug to ensure the patient actually takes the medication," Altman said. Enlisting the guidance of pharmacists is one way to boost patient adherence to drug regimens, he believes.
Cardiologist Dr. Jonathan Halperin is professor of medicine at Icahn School of Medicine at Mount Sinai in New York City. "The bottom line," he said, "is that the benefit of these new treatments depends upon taking the medication properly, and finding ways to help patients do so is an important aspect of care to prevent stroke."
The study was published April 14 in the Journal of the American Medical Association.
The U.S. National Library of Medicine has more about blood thinners.