How do people with and without dementia use anticoagulants? Systematic literature review and analyses of PBS data
Oral anticoagulants are medicines used to prevent stroke, heart attack and other blood clots. People with dementia are less likely to be prescribed anticoagulants than people without dementia, although they are equally likely to experience stroke. The most commonly prescribed anticoagulant is warfarin. Warfarin may cause serious adverse effects including bleeding in gastrointestinal tract or brain. Newer direct oral anticoagulants (DOACs) offer potential advantages to people with dementia as they don’t require a regular blood test, have fewer interactions and have more convenient dosing. However, the safety of DOACs has not been established for people with dementia. People with dementia were excluded from participating in clinical trials of DOACs. This research will investigate how anticoagulants are being prescribed to Australians with dementia. This will help to target interventions to minimise the risks associated with anticoagulant use. This research will assist clinicians to better care for people with dementia.
People with dementia are equally likely to experience stroke than those without dementia, however, less likely to use warfarin. It is not known how warfarin and direct oral anticoagulants (DOACs) are being prescribed to Australians with dementia. The objective of this research is to investigate the use of oral anticoagulants in Australians with Alzheimer’s disease (AD). A longitudinal study using a 10% random sample of the Australian Pharmaceutical Benefits Scheme data 2010-2016 will be conducted. People using anti-dementia medicines will be compared to people not using anti-dementia or antipsychotic medicines. Initiation of an oral anticoagulant will be defined as the first dispensing of an oral anticoagulant within a six-month period. Analyses will be adjusted for age, sex, area of residence, diagnoses and use of interacting medicines. The uptake of DOACs in people with and without AD will be described graphically. Generalised Estimating Equations will be used to analyse pathways of oral anticoagulant use in people with and without AD. Logistic regression will be used to compare characteristics of DOAC and warfarin use in people with and without AD. This research will help to target interventions to optimise anticoagulant use and assist clinicians to provide better care for people with dementia.
Dr Ilomäki is a NHMRC Early Career Fellow working at Monash University, Centre for Medicine Use and Safety. She does research in pharmacoepidemiology.