Effects of polypharmacy on the safety of anticoagulant treatment in burn patients — a retrospective analysis of clinical cases

   The article is devoted to the problem of safety of anticoagulant use in patients with burn injury against the background of polypharmacy. A retrospective analysis of 100 medical records of inpatients in the burn department who received anticoagulants for the prevention of venous thromboembolic complications (VTEC) was conducted for the period from 2022 to 2023, in order to study the safety of using anticoagulants in burn department patients with polypharmacy. According to the analyzed data, in patients taking anticoagulants in prophylactic doses and receiving more than 3 drugs simultaneously, in addition to changes in some clinical and laboratory parameters and coagulogram parameters (a significant increase in the number of blood leukocytes by 18 % (p ≤ 0.002), alanine aminotransferase (ALT) by 61 % (p ≤ 0.0001), aspartate aminotransferase (AST) by 32 % (p ≤ 0.0001), international normalized ratio (INR) by 11 % (p ≤ 0.02), activated partial thromboplastintime (APTT) by 7 % (p ≤ 0.0001), there is an increase in the length of the patient's hospital stay by 7 days (by 85 %, p ≤ 0.00003), compared with those who received less than 3 drugs.

1. Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012 Sep;65(9):989-95. doi: 10.1016/j.jclinepi.2012.02.018.

2. Foerster KI, Hermann S, Mikus G, Haefeli WE. Drug-Drug Interactions with Direct Oral Anticoagulants. Clin Pharmacokinet. 2020 Aug;59(8):967-980. doi: 10.1007/s40262-020-00879-x.

3. Payne RA, Avery AJ, Duerden M, et al. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol. 2014 May;70(5):575-81. doi: 10.1007/s00228-013-1639-9.

4. Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010. BMC Med. 2015 Apr 7;13:74. doi: 10.1186/s12916-015-0322-7.

5. Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions. Expert Opin Drug Saf. 2012 Jan;11(1):83-94. doi: 10.1517/14740338.2012.631910.

6. Astrand B. Avoiding drug-drug interactions. Chemotherapy. 2009; 55(4):215-20. doi: 10.1159/000218100.

7. Eggebrecht L, Nagler M, Göbel S, et al. Relevance of Polypharmacy for Clinical Outcome in Patients Receiving Vitamin K Antagonists. J Am Geriatr Soc. 2019 Mar;67(3):463-470. doi: 10.1111/jgs.15712.

8. Sychev IN, Fedina LV, Gabrielyan DA, et al. Anticoagulant therapy with direct oral anticoagulants in the context of polypragmasy: a course to safety. Meditsinskiy Sovet. 2022;16(17):52-64. (In Russ.) doi: 10.21518/2079-701X-2022-16-17-52-64.

9. Sychev DA. Polypharmacy in clinical practice: problems and solutions : study guide. Ed by. DA Sychev. 2^nd ed., corrected and supplemented. St. Petersburg: Profession, 2018. (In Russ.) ISBN 978-5-91884-106-8.