While alternative oral anticoagulant drugs such as dabigatran have recently been developed, warfarin is currently still the most commonly used and only PBS-listed oral anticoagulant in Australia for the prevention and treatment of thromboembolism in patients with mechanical heart valves, atrial fibrillation and deep vein thrombosis or pulmonary embolus. Warfarin exerts its therapeutic action as a vitamin K antagonist, lowering the amount of vitamin K available for the production of important clotting factors.
Download the bulletin:
Download (PDF, 18.48KB)
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
antibiotics,
interaction,
RGH E-bulletin,
warfarin
With the use of decision support software now commonplace, clinicians can find themselves on the receiving end of a constant barrage of information about potential contraindications and drug interactions. At times, there is a “fatigue factor” that might contribute to a prescriber, pharmacist or nurse overlooking a truly important warning that could avert a harmful drug interaction. The purpose of this E-Bulletin is not to add to the load of information, but rather to highlight some relatively commonly encountered drug interactions that are potentially clinically significant: the list below is by no means exhaustive, but does draw attention to drug combinations that should always be assessed critically when encountered in a medication profile or a drug chart
Download the complete bulletin:
Download (PDF, 12.17KB)
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
drug interactions,
Lithium,
RGH E-bulletin,
warfarin
The latest RGH E-Bulletin focuses our attention on anticoagulation. With more and more of the population taking anticiagulants understanding the factors for patient variability becomes more important.
The single most major concern in connection to anticoagulant use is the risk of bleeding. Perhaps the biggest driver of this concern is increasing intensity of anticoagulation. Often there is unpredictable variability in patient response to anticoagulant therapy that may inadvertently lead to overanticoagulation and subsequent bleeding.
Most variability in response to warfarin is driven by two genetic elements – the vitamin K epoxidase system, which is the basis for the action of warfarin, and the cytochrome P450 2C9 liver enzymes responsible for warfarin metabolism. As a result, daily maintenance doses can range from 0.5 mg – 20 mg/day.
Read the entire bulletin:
Download (PDF, 84.61KB)
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
anticoagulants,
anticoagulation,
bleeding,
coagulation,
enoxaparin,
fondaparinux,
heparin,
RGH E-bulletin,
Vitamin K,
warfarin
Warfarin has been shown in previous studies to prevent approximately 68% of strokes in atrial fibrillation, but close monitoring, drug and dietary interactions and risk of haemorrhage make it a difficult and inconvenient agent to use. Dabigatran is advantageous in many of these aspects, requiring comparatively little monitoring, having few drug interactions, being associated with an apparently decreased risk of intracranial haemorrhage relative to warfarin.
However, anticoagulation with dabigatran is non–reversible and the increased rate of gastrointestinal adverse effects is concerning. Futhermore, dabigatran appeared to be associated with an increased risk of myocardial infarction, a finding not adequately explained in this study.
Read the complete bulletin:
Download (PDF, 93.97KB)
The 2009 RGH E-Bulletins are archived by topic
here.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
Tagged as:
Dabigatran,
Pradaxa,
RE-LY,
RGH E-bulletin,
warfarin
