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Australian Reports of Bleeding Complications Associated with Antithrombotic Drug Combinations
Author(s) -
Ghiculescu Razvan A,
Pillans Peter
Publication year - 2008
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/j.2055-2335.2008.tb00792.x
Subject(s) - medicine , antithrombotic , clopidogrel , aspirin , warfarin , antiplatelet drug , anticoagulant , fibrinolytic agent , gastrointestinal bleeding , surgery , atrial fibrillation
Background The Australian Adverse Drug Reactions Advisory Committee (ADRAC) has received numerous reports of bleeding complications associated with the combined use of antithrombotic drugs (anticoagulants and/or antiplatelet drugs). Aim To review the ADRAC reports of major bleeding complications and determine the antithrombotic drug combinations implicated; and to establish the relevance of the voluntary ADRAC reporting data by comparing with published reports. Method ADRAC reports over a 6 year period from 1 January 2000 to 31 December 2006 were reviewed on the antithrombotic drugs involved, and the severity and nature of bleeding complications. Data were collated on patient demographics, and comorbidities. Results Bleeding complications related to the combined use of antithrombotic drugs were described in 188 ADRAC reports over the 6 year period. 17.5% of the reports had a fatal outcome. The median age of patients was 76 years, 47% were men and the principal comorbid condition was renal impairment (8.5%). The antithrombotic drug combinations associated with the risk of mortality included aspirin and/or clopidogrel and heparins; aspirin and/or clopidogrel and warfarin; aspirin and/or clopidogrel co‐prescribed with heparins and glycoprotein IIb/IIIa inhibitors; aspirin and heparins co‐prescribed with tissue plasminogen activator drugs. Bleeding was reported to occur in the upper gastrointestinal tract (26%), central nervous system (21%) and retroperitoneal space (16%). Of the reports of cerebral haemorrhage, 14 reports (35%) were associated with mortality. Conclusion ADRAC reports of major bleeding complications involving vital organs were associated with the combined use of anticoagulant and/or antiplatelet drugs and were frequently reported in older patients. These observations were supported by similar findings in published reports. These data highlight the risk associated with the use of antithrombotic drug combinations and the need for care in the clinical monitoring of patients.