Background Although the use of heparins is widespread, a proper evaluation of their clinical use is often difficult due to differences in the Regulatory Guidance Drug Registration (RGDR) for each type of indication and dosage.
Purpose By following the Drug International Guidelines, we aimed to evaluate the use of all prescribed heparins over 3 months at our hospital.
Material and methods All ‘single dose’ prescriptions, derived from all clinical and surgery divisions except for the orthopaedic division, were recorded and validated by the hospital pharmacy using a central computerised system. All prescriptions were analysed by selecting the type of heparins used associated with the diagnosis for each patient. The drug use evaluations were calculated (%) by analysing the type of indication (I) and dosage (D) for each patient. The indications and dosages were compared with the RGDR.
Results 1090 patients were treated with enoxaparin (2.7%), fondaparinux (11%), reviparin (6.7%), parnaparin (16.4%) and nadroparin (63.2%). The most common diagnoses were: (1) deep vein thrombosis prophylaxis in major surgery patients (50%) and (2) high risk of deep vein thrombosis prophylaxis in medical patients (41.9%). In line with the international guidelines, 457 medical patients were at a high risk of deep vein thrombosis: heart failure (24%), respiratory or cardiac failure (20%), cancer and chemotherapy (13%), atrial fibrillation (11%), previous stroke or myocardial infarction (8%), high risk pregnancy (6%), decompensated diabetes (4%), sepsis (3%), burns or paraplegia (2%) and more (9%). Drug use evaluation was as follows: enoxaparin (I=100%-Dα=49%); fondaparinux (Iβ= 78.4%-Dα=49%); reviparin (I=100%-Dα=19.6%); parnaparin (I=100%-Dα=30.7%); and nadroparin (Iπ=40.4%-Dα=47.3%).
αUse higher dosages not indicated in (1) and (2).
βUsed in (2) in non-acute patient.
πUse in (2) not indicated in RGDR.
Conclusion Our study demonstrated that the proper use of heparins may not always be in line with the RGDR. This may be due to the fact that clinicians prescribe heparins in the prophylaxis and treatment of venous thromboembolism without indicating the specific type of molecules but considering them as a unique type of drug. Therefore, the use of heparins may be ameliorated by providing clinicians with a more guided treatment plan that follows the RGDR.
References and/or Acknowledgements Drug International Guidelines (ACCP, NICE).
No conflict of interest.
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