Background: Anticoagulants remain the mainstay for the management of cardiovascular and thromboembolic disorders. The growing utilization of polypharmacy associated with polymorbidities presents a significant challenge in anticoagulant management, increasing the risk of potential drug–drug interactions (pDDIs).
Objectives: The objectives of this study were to assess the prescribing practices of anticoagulants and to analyse the impact of polypharmacy and pDDIs in patients receiving anticoagulant drug therapy in a secondary care hospital.
Methods: A prospective observational study was undertaken based on data from electronic medical records of prescriptions for anticoagulants between January and June 2023. The data were collected, analyzed for prescribing patterns, and checked for pDDIs using Micromedex database 2.0®. Utilising binary logistic regression, the relationship between polypharmacy and sociodemographic factors was assessed. Multivariate logistic regression analysis served to uncover determinants linked to pDDIs.
Results: Of the total 130 patients, the majority were females (58.46%), and the prevalence was higher in patients aged 61-90 years. Apixaban (51.53%) topped the list of frequently received anticoagulants within the study population, with atrial fibrillation being the most common diagnosis for its use. A total of 766 pDDIs were identified, of which 401 (52.34%) were moderate, 343 (44.77%) were major, and 22 (2.87%) were minor interactions. Binary logistic regression showed that polypharmacy was strongly linked to age (p=0.001), the Charlson comorbidity index (p=0.040), and comorbidities (p=0.005). In the multivariable analysis, the number of medications strongly predicted pDDIs (adjusted OR: 30.514, p=0.001).
Conclusion: A significant segment of the cohort receiving anticoagulant therapy in the study exhibited polypharmacy and pDDIs, with significant correlations with age, CCI, comorbidities, and the number of medications. A multidimensional approach involving collaboration among healthcare providers and clinical decision support systems can help integrate the management of polypharmacy and multimorbidity, minimize the risks of pDDIs, and ultimately enhance health outcomes.
