[Pharmacy GRIT article no: 20241399]

Anticoagulation reversal is often a critical measure for the timely and effective management of catastrophic bleeding in anticoagulated patients. Whilst the evidence that supports the use of reversal and/or pro-haemostatic agents on improving patient outcomes is limited, local institutional and national guidelines still recommend their use for life-threatening bleeding and under haematology advice.^1,2 Therefore, given the high-risk nature of anticoagulant use, I chose to undertake a retrospective medication use evaluation (MUE) on anticoagulation reversal as it would be of considerable value to the health service.

This MUE was the first research project that I conducted as the primary investigator, which gave me a significant amount of freedom but also the responsibility of ensuring the design of the project was suitable to address the research questions. The process for obtaining my sample size was significantly more efficient through the functionalities available in our electronic medical record, but I came to realise that even this system had its limitations. For example, being able to quickly obtain a report with all patients prescribed a particular reversal/pro-haemostatic agent within a certain period seemed extremely beneficial until you then need to filter out extremely large numbers of patients that received the reversal agent for a non-reversal indication.

In retrospect, it is interesting to see the ways that each problem I had to troubleshoot could affect my results and in turn, the conclusions I could then draw from the data. The results obtained from this MUE highlighted that there were improvements that could be made on standardising and improving anticoagulation reversal in the health service.

Anticoagulation reversal was an area that I knew very little about at the start of this project, but it was a topic that I was keen to learn about and apply to my own clinical pharmacy practice. Although this would certainly be a much larger undertaking than the MUE that I have completed; if I were to complete this audit again or another similar, I would aim to design the outcomes of the research such that I could also investigate the clinical outcomes on patients. I acknowledge that this will require a tremendous amount of additional time and effort to complete but may potentially better inform our health service on how to optimise current practice and patient care.

The knowledge and experiences that I have gained from completing the MUE will definitely carry on to any future research that I do. From having a better understanding of the quality assurance applications to an appreciation of the long timeline required to undertake these audits to learning of the nuances in scientific writing, many lessons have been learnt. Although the final analysis of the results is complete, the next step may arguably be the most important. MUE’s should be conducted with the goal of optimising patient care and safety. Ideally, the findings of this MUE will be utilised to guide making meaningful changes to the practices around anticoagulation reversal in this health service to ultimately improve patient health outcomes.

References

1. Tran H, Joseph J, Young L, McRae S, Curnow J, Nandurkar H, et al. New oral anticoagulants: a practical guide on prescription, laboratory testing and peri-procedural/bleeding management. Intern Med J 2014; 44: 525–536.
2. Tran HA, Chunilal SD, Harper PL, Tran H, Wood EM, Gallus AS. An update of consensus guidelines for warfarin reversal. Med J Aust 2013; 198:198–199.