title: Switching, Adverse Effects and Use of Over-the-Counter Analgesics among Users of Oral Anticoagulants: A Pharmacy-based Survey.
abstract: Oral anticoagulants are widely used but information on important aspects in that respect is not available from medical registers or clinical databases. Therefore, we conducted a survey including patients filling a prescription for oral anticoagulants at two large Danish community pharmacies. We collected information concerning the patients' knowledge of their anticoagulant treatment including prior drug switching. Further, patients were asked about use of over-the-counter analgesics, adverse effects and how the treatment affected their everyday life. Among 335 eligible patients, 301 (90%) agreed to participate. Atrial fibrillation was the most common indication (65%), and most patients filled a prescription for a non-vitamin K antagonist oral anticoagulant (NOAC) (58%). Among the 12% (n = 35) of participants who had switched oral anticoagulant treatment, 69% had switched from a vitamin K antagonist (VKA) to a NOAC. Switching was most frequently caused by inconvenience (34%) and adverse effects (23%). Although half of all patients had recently bought over-the-counter analgesics, purchase of ibuprofen and aspirin was rare (6%). More VKA users than NOAC users felt limited in their everyday life because of anticoagulant treatment (18% versus 9%). Among non-incident NOAC users, 21% had experienced adverse effects during their current treatment. Based on first-hand information from a large sample of anticoagulant users, we conclude that the main drug-related issues leading to anticoagulant switching and perceived limitations in everyday life were inconvenience and adverse effects. This varied between drug groups. Further, use of NSAIDs obtained over the counter was rare.
authors.affiliation: Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.|OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
authors.forename: Maja
authors.initials: M
authors.lastname: Hellfritzsch
authors.affiliation: Copenhagen Sønderbro Pharmacy, Copenhagen, Denmark.
authors.forename: Lea Maria Rønneberg
authors.initials: LMR
authors.lastname: Hyllested
authors.affiliation: Marselisborg Pharmacy, Højbjerg, Denmark.
authors.forename: Line
authors.initials: L
authors.lastname: Meegaard
authors.affiliation: Copenhagen Sønderbro Pharmacy, Copenhagen, Denmark.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wiberg-Hansen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.|Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Erik Lerkevang
authors.initials: EL
authors.lastname: Grove
authors.affiliation: Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.|Copenhagen Sønderbro Pharmacy, Copenhagen, Denmark.
authors.forename: Anton
authors.initials: A
authors.lastname: Pottegård
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000494:pharmacology* / Q000627:therapeutic use; D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use; D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003718:Denmark; D057915:Drug Substitution / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D004366:Nonprescription Drugs / Q000494:pharmacology* / Q000627:therapeutic use; D010594:Pharmacies / Q000706:statistics & numerical data; D010865:Pilot Projects; D055553:Prescription Drugs / Q000494:pharmacology* / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D000925:Anticoagulants; D004366:Nonprescription Drugs; D055553:Prescription Drugs; D001241:Aspirin; D007052:Ibuprofen