A Study of Prescribing Habits of Low Molecular Weight Heparin in Cardiovascular Disease in Tertiary Care Hospital
Background and Objective: Cardiovascular Diseases (CVDs) are the leading non-communicable diseases and also leading cause of morbidity and mortality worldwide. Low Molecular Weight Heparin (LMWHs) is frequently prescribed medication in CVDs. Prescribing pattern of LMWHs in CVDs is necessary to recommends modifications to achieve rational and cost-effective medical care.
Methodology: An inpatients hospital based observational prospective study for a period of six months was carried out. Data was collected from patient medication sheet and analyzed by suitable methods and standard references.
Results and Discussion: In our study, a total of 120 patients were enrolled out of 120 patients 84 were male and 36 were female. Antiplatelet drug is maximum prescribing drug in 98 (81.34%) patients out of 120, then after hypolipidaemic drugs in 94 (78.02%), Anticoagulant in 92 (76.36%), Antibiotics in 90 (74.70%), Antianginal in 69 (57.27), Antihypertensive in 64 (53.12%), Diuretics in 59 (48.97%). LMWHs are prescribed in 78 (65%) in which Enoxaparin is prescribed in 67(55%) and Dalteparin in 11(10%) patients out of 120 patients. Total 259 Drug-Drug Interactions (DDI) were found in which 67 were Major, 140 were Moderate, and 52 were Minor.
Conclusion: The study show LMWHs are highly prescribed category of anticoagulant. Enoxaparin is prescribed morethan Dalteparin. Antiplatelet drugs are prescribed to every patient who is prescribed with LMWHs to prevent embolic event. Chance of DDI is increases with these combinations. LMWHs and Fibrinolytic drugs are very costly and impart maximum economic burden to middle class family.
Ajay, V. S., & Prabhakaran, D., (2010). Coronary heart disease in Indians: implications of the INTERHEART study. Indian Journal of Medical Research, 132, 561–566
Alteplace price in India, Drugs update.com (2017). http://www.drugsupdate.com/brand/showavailablebrands/140. Accessed 05 April 2017.
Antman, E. M., Anbe, D. T., Armstrong, P. W., Bates, E. R., Green L. A., Hand, M., et al. (2005). ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: Executive summary. Circulation, 110, 588–636. https://doi.org/10.1161/01.CIR.0000134791.68010.FA
Balady, G. J., Williams, M. A., Ades, P. A., Bittner, V., Comoss. P., Foody, J. M., et al. (2007). Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation, 115, 2675–2682. https://doi.org/10.1161/CIRCULATIONAHA.106.180945
Banerjee, S., Kumar, V., Ramachandran, P., & Kamath, A. (2010). Does the pharmacological management of unstable angina vary with age and gender – a descriptive study. Journal of Clinical and Diagnostic Research, 4, 3150–3157.
Cardiovascular diseases in India (2010). http://www.neemanmedical.com/sites/default/files/files/Cardiovascular%20Diseases%20in%20India_0.pdf. Accessed 10 July 2016.
Chauhan, S., & Aeri, B. T. (2013). Prevalence of cardiovascular disease in India and its economic impact- A review. International Journal of Scientific and Research Publications, 3(10), 1–5.
Dipiro, J. T. (2008). Pharmacotherapy A Pathophysiologic Approach. Seventh edition. New York: Mc Grow Hill.
Eikelboom, J. W., Quinlan, D. J., Mehta, S. R., Turpie, A. G., Menown, I. B., & Yusuf, S. (2005). Unfractionated and low-molecular-weight heparin as adjuncts to thrombolysis in aspirin treated patients with ST-Elevation acute myocardial infarction: A meta-analysis of the randomized trials. Circulation, 112, 3855-3867. https://doi.org/10.1161/CIRCULATIONAHA.105.573550
Enas E. A., (2007). How to beat the heart disease epidemic among South Asians: A prevention and management guide for Asian Indians and their doctors. Downers Grove: Advanced Heart Lipid Clinic USA.
Goldhaber, S. Z., (2005). “Pulmonary thromboembolism”. In Kasper, D. L., Braunwald, E., Fauci, A. S., et al. (ed. 16th,) Harrison’s Principles of Internal Medicine (pp. 1561-1565). New York: McGraw-Hill.
Gruppo Italiano per Lo Studio della Sopravvivenza Nell’infarcto Myiocardio, (1990). GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet, 336, 65–71.
Muntwyler, J., Noseda, G., Darioli, R., Gruner, C., Gutzwiller, F., & Follath, F. (2003). National survey on prescription of cardiovascular drugs among outpatients with coronary artery disease in Switzerland. Swiss Medical Weekly, 133, 88–92.
Krumholz, H. M., Anderson, J. L., Brooks, N. H., Fesmire, F. M., Lambrew, C. T., Landrum, M. B., et al. (2006). ACC/AHA clinical performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: A report of the American College of Cardiology/ American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures on ST-Elevation and Non- ST-Elevation Myocardial Infarction). Journal of the American College of Cardiology, 47, 236–265. https://doi.org/10.1016/j.jacc.2005.10.020
Levine, G. N., Berger, P. B., Cohen, D. J., Maree, A. O., Rosenfield, K., Wiggins, B. S, et al. (2006). Newer pharmacotherapy in patients undergoing percutaneous coronary interventions: A guide for pharmacists and other health care professionals. Pharmacotherapy, 26, 1537–1556. https://doi.org/10.1592/phco.26.11.1537
Scarvelis, D., & Wells, P. (2006). Diagnosis and treatment of deep-vein thrombosis. Canadian Medical Association Journal, 175(9), 1087–1092. https://doi.org/10.1503/cmaj.060366
Sreptokinase price in India, Drugs update.com (2017). http://www.drugsupdate.com/brand/brand_name/. Accessed 05 May 2017.
Srishyla, M. V., Krishnamurthy, M., Nagarani, M.A., Andrade, C., & Venkataraman, B.V. (1994). Prescription audit in an Indian Hospital setting using the DDD concept. Indian Journal of Pharmacology, 26, 23–28.
Sandozi, T., & Nausheen, F. (2010). Drug utilization study in ischemic heart diseases associated with diabetes and hypertension. International Journal of Pharma and Bio Sciences, 1(3), 1–4.
WHO. Cardiovascular diseases (CVDs) Fact sheet No. 317, September 2011.
Copyright (c) 2017 Madhaw Dwivedi, S. M. Biradar, Ajay Pandey, Anand P. Ambali, Rishu Sharma
This work is licensed under a Creative Commons Attribution 4.0 International License.
Articles in Journal of Pharmaceutical Technology, Research And Management (J. Pharm. Technol. Res. Manag.) by Chitkara University Publications are Open Access articles that are published with licensed under a Creative Commons Attribution- CC-BY 4.0 International License. Based on a work at https://jptrm.chitkara.edu.in. This license permits one to use, remix, tweak and reproduction in any medium, even commercially provided one give credit for the original creation.
View Legal Code of the above mentioned license, https://creativecommons.org/licenses/by/4.0/legalcode
View Licence Deed here https://creativecommons.org/licenses/by/4.0/
|Journal of Pharmaceutical Technology, Research And Management by Chitkara University Publications is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at https://jptrm.chitkara.edu.in