Related Experiment Video
Updated: May 22, 2025
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Triggers for identifying anticoagulation-associated adverse drug events in hospitalized patients: a systematic review
Uyen Thi Nguyen1,2, Khanh N C Duong2,3, Phuong Thi Lan Nguyen2
1National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi University of Pharmacy, Hanoi, Vietnam.
Background:
Anticoagulation therapy presents a high risk of adverse drug events (ADEs) in hospitalized patients, highlighting the need for effective detection strategies in clinical practice.
Aim:
The review aimed to identify triggers for detecting anticoagulation-associated ADEs in hospitalized patients and describe the performance of these triggers.
Method:
PubMed, Cochrane, and Embase were queried until April 19, 2024. We included studies on trigger tools for detecting anticoagulation-related ADEs in hospitalized patients. The study quality was assessed using the Quality Assessment Trigger framework based on the QUADAS-2 tool for diagnostic accuracy. We performed random-effects meta-analyses to pool positive predictive values (PPV), with heterogeneity assessed via I2 statistic and Cochran's Q test.
Results:
Twenty-three studies were included. Seventeen triggers were reported and categorized into three modules: abnormal laboratory values (11 triggers), medications or antidotes (three triggers), and care (three triggers). Elevated international normalized ratio (INR) was the most prevalent trigger (16 studies) with a PPV of 0.539 (95% Confidence Interval [CI] 0.310-0.768). Other triggers exhibited lower pooled PPVs than elevated INR, including vitamin K administration (15 studies, PPV 0.222, 95% CI 0.153-0.290), abrupt medication cessation (14 studies, PPV 0.418, 95% CI 0.169-0.667), and activated partial thromboplastin time > 100 s (11 studies, PPV 0.336, 95% CI 0.173-0.498). Importantly, in-hospital stroke (three studies) had the highest pooled PPV of 0.964 (95% CI 0.803-1.000).
Conclusion:
This review demonstrated the variability in PPVs of triggers for anticoagulation-associated ADEs, emphasizing the necessity for a specialized trigger tool for hospitalized patients on anticoagulants.
Related Concept Videos
01:19Pharmacovigilance
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:15Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...