Blood Thinners Pose Risks Without Proper Oversight

A new report from the Washington Post indicates that the negative health effects of the anticoagulant Coumadin and its generic version, warfarin, may be more extensive than originally suspected (https://wapo.st/1O0pLrc). From 2011 to 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or warfarin. However, other studies suggest that thousands of other related injuries go unreported each year, largely because the government only seems interested in investigating cases that cause a stir or bring about complaints.

“Its an insidious problem,” Rob Baird, president of Geriatric Practice Management, a firm that creates electronic health records for physicians working in long-term care facilities, told the Post. “Coumadin is the most dangerous drug in America.”

That danger comes from the tenuous balance that must be walked in the patient’s usage and monitoring of drugs like Coumadin. With too much of the drug, one runs the risk of uncontrollable bleeding; with too little, clots begin to form, leading to life-threatening health risks.

For years, many industry professionals warned about the practitioners’ overreliance on antipsychotic medications that put elderly patients with dementia or Alzheimer’s disease in a trance that ultimately increased their risk of life-threatening falls. The awareness brought to the problem resulted in a national initiative that helped to reduce the usage of such drugs in LTCFs by 20% between the end of 2011 and 2014.

However, the dangers of Coumadin have drawn comparatively little scrutiny, perhaps because of the extensive use of the drug and its clear benefits in preventing blood clots. Yet, the danger remains, with unmonitored and improper usage causing patients around the country profound suffering and, in some case, likely hastening their deaths.

Indeed, a 2007 peer-reviewed study in the American Journal of Medicine estimated that nursing home residents experience ~34,000 fatal, life-threating or serious events related to the drugs each year.¹ Likewise, a more recent 2012 study found more medication errors relating to Coumadin than to any other drug.² Often, these errors come from poor monitoring on the part of staff, as the drug interacts poorly with certain foods, medications and antibodies, and regular blood tests must be taken to ensure that the drug is working as intended. When a resident reacts negatively to the drug, large, discolored bruises begin to appear on the body, necessitating quick action to counteract the drug’s effects with large doses of vitamin K. (In fact, it is this ability to counteract warfarin’s effects with vitamin K, in contrast with the other anticoagulants on the market that lack effective antidotes, that makes it such a favorite choice among physicians.)

Experts agree that those who are taking Coumadin need it. But the question is one of monitoring: care facility staff and caretakers must pay close attention to how individuals are reacting to the drug. The American Health Care Association has recently announced a quality initiative aimed at reducing “unintended health outcomes,” including those of Coumadin and other anticoagulants.³ Although doctors need not be discouraged from prescribing these drugs, more should be done to understand their limitations and the need to implement practices that safeguard the health of patients. —Sean McGuire

1.    Gurwitz JH, Field TS, Radford MJ, et al. The safety of warfarin therapy in the nursing home setting. Am J Med. 2007;120(6):539‚Äì544.

2.    Williams CE, Greene SB, Hansen RA, Pierson S, Desai R. NC Nursing Home Medication Error Quality Initiative (MEQI), Annual Report FY2012, October 1, 2011 to September 30, 2012. Chapel Hill, NC: The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill; 2012.

3.    The AHCA quality Initiative. http://bit.ly/1bmFyTf. Accessed July 30, 2015.