Bleeding is the major risk associated with all antithrombotics

What the following notice to medical practitioners does not mention is the over-prescribing of these drugs for many conditions that may be extremely well managed by nutritional interventions, stress management and  other measures such as stopping smoking.  It just seems that it is so much easier to write the patient a script and shove them out the door!

Less than 10% of all adverse reactions get reported and this may be as low as 1%, so the figures below for New Zealand are alarming.  So, what's the true level of harm?

It is interesting to note the disastrous effects of combination therapies, particularly with anti-inflammatories and depression pills, both of which are prescribed with gay abandon in this country.

What statistics do not tell us is the misery that many of the affected individuals and their families suffer as a consequence.  The consequences include disabling brain damage and some deaths.

While the prescribing of anti-clotting drugs may be necessary during acute occasions and following certain surgical procedures, there are few cases, in my opinion, that require this medication for life.

If you, or a loved one, are on these drugs, keep going back to your doctor and ask "when am I going to be able to stop?"  Has your doctor got a proper treatment plan for your ill-health, or not?  If there is no light at the tunnel, then seek a second opinion.  If you are still feeling uneasy, keep looking for healthy long-term solutions.  They are out there.

Notice below.

Gary
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Anticoagulants and antiplatelet agents (antithrombotics) are widely used to treat a number of conditions, with recent guidance on their use being issued by the Best Practice Advocacy Centre (BPAC)¹.

Bleeding is the major risk associated with all antithrombotics. The Centre for Adverse Reaction Monitoring (CARM) continues to receive reports of serious bleeds experienced by patients taking these medicines.

An overview of 12 months of reporting to CARM is shown in Table 1. The main sites of serious bleeding were most often gastrointestinal or intracranial in origin.

Only a small fraction of suspected adverse reactions are reported to CARM, nevertheless these reports show that serious bleeds do occur with antithrombotics and that some bleeds may have been preventable. For example, although combination therapy is recommended for some conditions, adverse reaction data continues to indicate a major risk factor for bleeding is the concomitant use of more than one antithrombotic medicine.

Early treatment of bleeds is desirable and patients and/or carers should be advised to monitor for early signs of bleeding.

Table 1: Antithrombotic CARM reports associated with bleeding from 1 Oct 2010 to 30 Sept 2011.

Medicine	Total number of reports	Number of reports of bleeding (%)	Number of cases reported to be exposed to another anticoagulant or antiplatelet agent (%)	Number of bleeding cases reported to also be exposed to a NSAID or SSRI (%)
Aspirin	28	68	53	42
Clopidogrel	9	67	100	16
Dabigatran*	212	42	59	3
Dipyridamole	3	67	100	50
Enoxaparin	14	50	57	0
Rivaroxaban	3	0	N/A	N/A
Warfarin	32	56	50	11

* Dabigatran has been recently introduced with rapid uptake

Key Messages

• A major risk factor for bleeds is the use of more than one antithrombotic medicine.
• Patients and/or carers should be advised to monitor for the early signs of bleeding.

References

1. A New Zealand Consensus Forum. 2011. The use of antithrombotic medicines in general practice: a consensus statement. Best Practice Journal, 39: 10-21

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