Wednesday, 7 September 2016

Is switching anticoagulants safe: Summer Vac student Fiona Chen investigates

Fourth year Bachelor of Medicine Bachelor of Surgery (MBBS) student Fiona Chen has had her systematic review of warfarin anticoagulants published in the Australian Medical Student Journal (AMSJ) as a result of research she undertook during the SPHPM Summer Vacation Scholarship Program.

Fiona took part in the program in 2013 and spent four weeks working with the clinical pharmacology team in the Centre of Cardiovascular Research & Education in Therapeutics (CCRET) under the late Professor Henry Krum.

The SPHPM Summer Vacation Scholarship Program, now in its sixth year, is a dynamic four-week program that runs over the University's summer vacation period. The aim of the program is to show undergraduate students the world of public health research by providing them with a means to engage, gain skills and experience in current research.

Fiona’s interest in warfarin, and warfarin clinical guidelines were a result of a conversation she had with clinical pharmacologist Dr Ingrid Hopper, Head of Drug and Device Registries at SPHPM.

“I became interested in the topic when one of the researchers in the office, Dr Ingrid Hopper, told me that there had been recent incidences in the hospital where a patient’s anti-coagulant had been switched accidentally to another brand despite clinical guidelines recommending not switching if possible,” Fiona said.

“Another patient missed their regular dose of warfarin due to staff being unable to source a patient’s particular brand at the time. Thankfully, no patients were harmed.”

“We then decided to systematically review the literature to make brand switching recommendations,” she said.

Warfarin is a blood-thinner, and is routinely prescribed in patients considered at risk of thrombosis, strokes and clotting on mechanical heart valves. It can also be used in the treatment of deep vein thrombosis and pulmonary embolism.

Fiona reviewed literature on warfarin studies, which looked at bioequivalence and incidents reported by the Therapeutic Goods Administration (TGA), noting that no studies directly compared the two Australian brands of warfarin, Coumadin and Marevan.

However, by systematically reviewing the available population studies, randomised controlled studies and observational studies she concluded that the literature supports existing guidelines which currently recommend continuing with the same brand of warfarin, if possible.

She also confirmed that in an in-patient setting, brand-switching is preferred to withholding a dose a dose of the preferred brand, with appropriate International Normalised Ratio (INR) testing.

She also concluded that phasing out formulations of warfarin so only one brand is available would be optimum and would resolve the confusion.

Fiona added that the experience of actively engaging in research was invaluable and would like to thank co-authors Dr Ingrid Hopper, Linda Graudins and Ian Wang for their assistance.

“The Summer Vacation program introduced me to the world of research, taught me essential journal writing skills and exposed the importance of medical literature in guiding clinical practice,” she said.

The program is open to all students studying a Bachelor of Health Science, Biomedical Science and the MBBS.

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