The Joint Commission, a healthcare provider accrediting and safety group, issued a special bulletin recently stating that an alarming number of patients nationwide have experienced major complications and died because blood thinners have been incorrectly administered.
Blood thinners such as warfarin (which is also known by its trade name Coumadin) and heparin prevent blood clots from forming. However, these medications also have a serious complication risk, said Peter Berger, MD, a Geisinger interventional cardiologist who has published extensively on this topic.
"The effects of these drugs are different from patient to patient," Dr. Berger said. "For instance, warfarin is more affected by other drugs than any other medication. And the strength of different vials of heparin varies more than people realize."
Geisinger individually tailors blood thinner dosage levels to patients based on their diet, other medications, and the desired thinning of their blood.
Geisinger also operates a system-wide outpatient anticoagulation clinic for patients with heart problems and those who have had a deep vein thrombosis or pulmonary embolism.
Patients' blood clotting rates are closely monitored depending on their blood thinner. Patients on heparin who are hospitalized are checked every six hours, while patients on warfarin are checked once daily. Patients who receive treatment at the clinic on an outpatient basis are checked every few weeks.
Patients also receive detailed information about how blood thinners work and how patients can avoid medication problems.
In addition, Geisinger pharmacists do not change dosing concentrations of blood thinners; only one concentration is used, which reduces the risk of miscalculating the dosing levels, said Dean Parry, RPh, Geisinger's director of clinical pharmacy programs. Geisinger also has special IV pumps that are designed to sound an alarm if a dose is given outside of safe range.
Since launching the anticoagulation clinic, Geisinger has reduced the number of bleeding complications, formation of new blood clots and other adverse events by 75%, Parry said. The number of patients within the ideal blood clotting rate range has also improved.
"These drugs significantly change a patient's clotting rate," Parry said. "It's important that patients cooperate in their care by maintaining a steady diet, letting their doctors know when they start a new medication and letting all caregivers know when they are on a blood thinner."
These safety measures are especially important for patients who undergo surgery. "When patients need an invasive procedure and are on warfarin, their medication management has to be carefully planned in advance," Dr. Berger said. "Too much of the drug can lead to excessive bleeding at the procedure site, while too little can cause blood clots."