Managing Anticoagulants, Antiplatelets Challenged Pharmacists During Pandemic

Unexpected changes in the need for oral and parenteral anticoagulant and antiplatelet medications kept hospital pharmacists on their toes during the COVID-19 pandemic. A new study tracked those changes using purchasing data by U.S. hospitals. Here are more details on which drugs were used more and which were used less.

LOS ANGELES – Hospitals and their pharmacy staff were challenged by rapid changes in the availability and usage of anticoagulants and antiplatelets in COVID-19 inpatients.

“Antithrombotic agents have a role in coronavirus disease 2019 (COVID-19) treatment, but the pandemic disrupted medication supply,” write researchers from the University of Southern California School of Pharmacy, Los Angeles and the Johns Hopkins Bloomberg School of Public Health in Baltimore. In response, the study team tracked changes in the volume of oral and parenteral anticoagulant and antiplatelet medications at U.S. hospitals during the pandemic.

The researchers used IQVIA National Sales Perspective (NSP) data to determine the monthly volume of anticoagulants and antiplatelets purchased at U.S. hospitals between January 2018 and February 2021, focusing on mean monthly medication volumes, reported as extended units (EUs), and year-over-year changes in medication volume. They then employed a single-group interrupted time series analysis to evaluate changes in the rate of growth of monthly medication volumes before (January 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic.

Results published in the American Journal of Health-System Pharmacy indicate that, overall, there was a 43.4% decline in the total volume of anticoagulants and antiplatelets at U.S. hospitals in March 2020, driven by a decrease in heparin volume.

Mean monthly volumes decreased significantly (P < 0.05) for parenteral anticoagulants (–106,691,340 EU [95% CI, –200,033,910 to –13,348,780]), oral anticoagulants (–354,800 EU [95% CI, –612,180 to –97,420]), and parenteral antiplatelets (–391,880 EU [95% CI, –535,420 to –248,330]).

https://academic.oup.com/ajhp/article-abstract/80/11/692/6960873?redirectedFrom=fulltext

“During the pandemic, the monthly volume of oral anticoagulants, parenteral anticoagulants, and parenteral antiplatelets grew significantly more than in the prepandemic period,” the study reports. “This growth was primarily seen in volumes of apixaban, argatroban, enoxaparin, heparin, eptifibatide, and tirofiban. Apixaban and heparin volumes continued a prepandemic uptrend, while argatroban and eptifibatide volumes reversed trend.”

The authors point out that “rapid changes in anticoagulant and antiplatelet volume at US hospitals during the COVID-19 pandemic highlight the need for institutional protocols to manage fluctuating medication volume demands.”

Clinical guidelines from the National Institutes of Health recommended that hospitalized patients with COVID-19 who experience rapid deterioration of pulmonary, cardiac, or neurological function or sudden, localized loss of peripheral perfusion be evaluated for thromboembolic disease.

https://www.covid19treatmentguidelines.nih.gov/therapies/antithrombotic-therapy/

The COVID-19 treatment guidelines panel further recommended that patients with COVID-19 who were receiving anticoagulant or antiplatelet therapies for underlying conditions continue these medications unless significant bleeding develops or other contraindications were present.

The panel also suggested that, when diagnostic imaging is not possible, patients with COVID-19 who were highly suspected to have thromboembolic disease be managed with therapeutic anticoagulation.

COVID-19 patients who required extracorporeal membrane oxygenation or continuous renal replacement therapy or who had thrombosis related to catheters or extracorporeal filters were urged to be treated with antithrombotic therapy as per the standard institutional protocols for those without COVID-19.