Anticoagulation-Associated Adverse Drug Events in Hospitalized Patients Across Two Time Periods.

Area of Science:

• Pharmacovigilance
• Patient Safety
• Health Informatics

Background:

• Anticoagulants are high-risk medications frequently associated with adverse drug events (ADEs), including medication errors and adverse drug reactions.
• Understanding trends in anticoagulation-associated ADEs is crucial for improving patient safety, especially following technological advancements.

Approach:

• This study retrospectively reviewed anticoagulation-associated ADEs reported between 2004-2009 (historical) and 2015-2020 (contemporary).
• Events were classified by type, severity, root cause, and patient harm, with follow-up to 30 days.
• Data from the contemporary period were compared to the historical period to identify changes in ADE characteristics and outcomes.

Key Points:

• Anticoagulation-associated ADEs increased in the contemporary period despite enhanced safety measures.
• Medication errors constituted the majority of ADEs (82.4%), with wrong rate or frequency of administration being the most common type.
• Unfractionated heparin remained the most frequent anticoagulant implicated in ADEs.

Conclusions:

• Anticoagulation-associated ADEs persist despite significant investments in patient safety technology and procedures.
• The findings highlight a need for continuous improvement in anticoagulant safety protocols to reduce medication errors and enhance patient outcomes.