Pharmacists call for more active role on blood thinners

Hospital pharmacists have called for an enhanced role in the prescription management of novel anticoagulants (NOACs), blood-thinning agents that prevent stroke.

Such a move would help tackle patient safety issues with the new drugs, as highlighted by recent reports of poor prescribing practices for NOAC patients, the Hospital Pharmacists’ Association of Ireland (HPAI) has said.

More than 13,000 HSE patients in Ireland receive treatment with NOAC drugs and the number is increasing rapidly.

In March the HSE wrote to GPs and other community healthcare staff warning of the risks of NOACs in relation to inappropriate dosing and the potential for drug interactions.

HSE auditing found some patients were being prescribed a dose that was too low to be effective while many patients were taking other drugs that could react badly with the NOAC they were taking.

Experience to protect
President of the HPAI, Deirdre Lynch, said it was vital that hospital pharmacists played a more active role in the management of NOAC prescribing, as they had the expertise to identify and protect patients from incorrect dosages and drug interactions.

“Hospital pharmacists are the solution to improving the safety around the use of NOACs. We could deliver on this if the appropriate structures were put in place through the implementation of the Hospital Pharmacy Career Structure Review, the recommendations of which were published almost two and a half years ago.”

Ms Lynch was speaking at the HPAI Annual Educational Conference, which took place in Dublin last weekend.

Prof Michael Barry, HSE National Lead of Medicines Management & Pharmacotherapeutic Interventions Programme and head of the National Centre for Pharmacoeconomics, gave the keynote address. He spoke about the opportunities the HSE's medicines management programme can afford to hospital pharmacists in facilitating safe, appropriate and cost-effective prescribing in the Irish health system.

Echoing Ms Lynch’s call, Prof Barry said hospital pharmacists could play a key role in helping to tackle the issues caused by poor quality prescribing of NOACs, as highlighted in his letter to GPs last month.

He said more than 70 per cent of patients on NOACs were over 70 years of age, and NOACs cost the HSE €15 million a year in direct drug costs. He said warfarin – an older blood thinning agent – when managed well was cheaper and just as effective and safe.