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Anticoagulant therapy: we have to do better! A systematic review
  1. Ed H Wiltink
  1. Correspondence to Ed H Wiltink, Department of Clinical Pharmacy and Pharmacology, St Antonius Hospital, PO Box 2500, Nieuwegein 3430 EM, The Netherlands; ewiltink{at}ziggo.nl

Abstract

Aim Anticoagulant therapy is considered a high-risk medication strategy with a narrow therapeutic window and the need for close monitoring, particularly with vitamin K antagonists. The nature of the drugs as well as the way they are administered make it more likely mistakes will occur. At all stages of care, ambulatory as well as in hospital, avoidable medication errors are seen. This review was performed to elucidate the number and nature of medication errors with anticoagulants and to look at possibilities for improving anticoagulant therapy.

Methods A literature review was performed in PubMed, Medline and other sources looking after articles concerning medication errors in which anticoagulants are separately mentioned. From these articles, the risk factors were identified.

Results A total of 17 papers were selected where medication errors with anticoagulant drugs were described. It became clear that medication errors occur from the doctor prescribing the medication, to the compliance of the patient with taking the treatment, and all steps in between. Communication between caregivers and between caregivers and patients seems to be an important factor.

Conclusions This review shows that improvement is possible throughout the whole anticoagulant medication chain, starting with instructions for those prescribing drugs to education for patients.

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