Author(s):
Vineetha Menon, Ahmed Mohamed Elgendy, Jisha Myalil Lucca
Email(s):
dr.vineetha@gmu.ac.ae
DOI:
10.52711/0974-360X.2026.00256 
Address:
Vineetha Menon1*, Ahmed Mohamed Elgendy2, Jisha Myalil Lucca3
1Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.
2Postgraduate Research Student, Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.
3Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.
*Corresponding Author
Published In:
Volume - 19,
Issue - 4,
Year - 2026
ABSTRACT:
Introduction: Antithrombotic agents, including anticoagulants and antiplatelet drugs, are vital for preventing and managing thromboembolic events but pose risks of adverse drug reactions, drug-drug interactions, and dosing challenges. Limited real-world data from the United Arab Emirates warrant evaluation of prescribing and monitoring practices. This study aimed to assess prescribed daily doses of antithrombotic agents against World Health Organization-defined daily doses, evaluate related adverse drug reactions and drug-drug interactions, and analyze clinical outcomes. Methods: A prospective observational study was conducted over seven months at a private academic hospital in Ajman, United Arab Emirates. Adult inpatients receiving antithrombotic therapy were included. Data on demographics, medications, laboratory results, adverse drug reactions, and drug-drug interactions were collected. The World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose methodology was applied. Results: Of 130 patients screened, 100 were included. Antiplatelet drugs were prescribed to 67% and anticoagulants to 33%, with enoxaparin being the most frequent agent. Deviations from World Health Organization-defined daily doses were common, including overprescription of enoxaparin and aspirin and underdosing of apixaban. Adverse drug reactions occurred in 17% of patients, most commonly hematuria and thrombocytopenia; all were mild and 90% were preventable. Drug-drug interactions occurred in 10%, mainly pharmacodynamic, with 67% classified as major. Monitoring of coagulation parameters was inconsistent, with most patients not achieving therapeutic targets. Conclusion: The study revealed significant dosing variability, frequent adverse drug reactions and drug-drug interactions, and inadequate monitoring. Enhanced adherence to dosing guidelines and improved medication safety practices are essential to optimize outcomes in antithrombotic therapy.
Cite this article:
Vineetha Menon, Ahmed Mohamed Elgendy, Jisha Myalil Lucca. Drug Utilization, Safety, and Clinical Outcomes of Antithrombotic Agents: Insights from Real-World Hospital Data. doi: 10.52711/0974-360X.2026.00256
Cite(Electronic):
Vineetha Menon, Ahmed Mohamed Elgendy, Jisha Myalil Lucca. Drug Utilization, Safety, and Clinical Outcomes of Antithrombotic Agents: Insights from Real-World Hospital Data. doi: 10.52711/0974-360X.2026.00256 Available on: https://www.rjptonline.org/AbstractView.aspx?PID=2026-19-4-45
12. REFERENCES:
1. Singh R, Chandi SK, Sran S, Aulakh SK, Nijjar GS, Singh K, et al. Emerging therapeutic strategies in cardiovascular diseases. Cureus. 2024 Jul 12; 16(7): e64388. doi:10.7759/cureus.64388.
2. Weitz JI, Chan NC. Novel antithrombotic strategies for treatment of venous thromboembolism. Blood. 2020 Jan 30; 135(5): 351-9. doi:10.1182/blood.2019000919.
3. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020 Dec 22; 76(25): 2982-3021. doi:10.1016/j.jacc.20.
4. IQVIA Institute. The global use of medicines 2022. Available from: https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/the-global-use-of-medicines-2022
5. El Kadri M, AlMuti K, Agrawal A, Bazargani N, Gamaleldin MFS, Ahmed HM, et al. The Atrial Fibrillation Registry (The FLOW-AF Registry): insights from the United Arab Emirates—patient characteristics, treatment, and one-year outcomes. J Cardiovasc Electrophysiol. 2025 Apr; 36(4): 813-23. doi:10.1111/jce.16598.
6. El Kadri M, Bazargani N, Farghaly M, Mohamed R, Awad N, Natarajan A, et al. Profiling clinical characteristics and treatment patterns among non-valvular atrial fibrillation patients: a real-world analysis in Dubai, United Arab Emirates. Open Med J. 2019; 6: 33. doi:10.2174/1874220301906010033.
7. Tiaden JD, Wenzel E, Berthold HK, Müller-Oerlinghausen B. Adverse reactions to anticoagulants and antiplatelet drugs recorded by the German spontaneous reporting system. Semin Thromb Hemost. 2005; 31(4): 371-80. doi:10.1055/s-2005-916670.
8. Fanikos J, Piazza G, Zayaruzny M, Goldberg RJ. Anticoagulation-associated adverse drug events in hospitalized patients across two time periods. Am J Med. 2023; 136(9): 927-36.e3.
9. Shehab N, Greenwald JL, Budnitz DS. Anticoagulation across care transitions: identifying minimum data to maximize drug safety. Jt Comm J Qual Patient Saf. 2017; 44: 627-9.
10. Piazza G, Nguyen TN, Cios D, Labreche M, Hohlfelder B, Fanikos J, et al. Anticoagulation-associated adverse drug events. Am J Med. 2011 Dec; 124(12): 1136-42. doi:10.1016/j.amjmed.2011.06.009.
11. Spector WD, Limcangco R, Furukawa MF. The marginal costs of adverse drug events associated with exposures to anticoagulants and hypoglycemic agents during hospitalization. Med Care. 2017; 55: 856-63.
12. Amaraneni A, Chippa V, Goldin J, et al. Anticoagulation safety. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. [cited 2024 Oct 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519025/
13. Ballestri S, Romagnoli E, Arioli D, Coluccio V, Marrazzo A, Athanasiou A, et al. Risk and management of bleeding complications with direct oral anticoagulants in patients with atrial fibrillation and venous thromboembolism: a narrative review. Adv Ther. 2023 Jan; 40(1): 41-66. doi:10.1007/s12325-022-02333-9.
14. Gajic-Veljanoski O, Phua CW, Shah PS, et al. Effects of long-term low-molecular-weight heparin on fractures and bone density in non-pregnant adults: a systematic review with meta-analysis. J Gen Intern Med. 2016; 31: 947-57. doi:10.1007/s11606-016-3603-8.
15. Sadeghi A, Zali MR, Mohaghegh Shalmani H, Ketabi Moghadam P, Rajabnia Chenari M, Karimi MA, et al. An algorithmic approach to gastrointestinal bleeding in patients receiving antithrombotic agents. Gastroenterol Hepatol Bed Bench. 2020 Winter;13(Suppl1):S8-S17.
16. Saheb Sharif-Askari N, Syed Sulaiman SA, Saheb Sharif-Askari F, Hussain AA. Adverse drug reaction-related hospitalisations among patients with heart failure at two hospitals in the United Arab Emirates. Int J Clin Pharm. 2015 Feb; 37(1): 105-12. doi:10.1007/s11096-014-0046-3.
17. Shen NN, Zhang C, Hang Y, Li Z, Kong LC, Wang N, et al. Real-world prevalence of direct oral anticoagulant off-label doses in atrial fibrillation: an epidemiological meta-analysis. Front Pharmacol. 2021 May 26; 12: 581293.
18. Sanghai S, Wong C, Wang Z, Clive P, Tran W, Waring M, et al. Rates of potentially inappropriate dosing of direct-acting oral anticoagulants and associations with geriatric conditions among older patients with atrial fibrillation: the SAGE-AF study. J Am Heart Assoc. 2020 Mar 17; 9(6): e014108. doi:10.1161/JAHA.119.014108. PMID:32146898.
19. Santos J, António N, Rocha M, Fortuna A. Impact of direct oral anticoagulant off-label doses on clinical outcomes of atrial fibrillation patients: a systematic review. Br J Clin Pharmacol. 2019;85(12):2764-78.
20. Resnick B, Ives A, Boltz M, Galik E, Kuzmik A, McPherson R. Appropriate antithrombotic management for older adults living with dementia. J Aging Longev. 2025; 5(2): 11.
21. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD toolkit – About DDD. Available from: https://www.who.int/tools/atc-ddd-toolkit/about-ddd
22. Grimmsmann T, Himmel W. Discrepancies between prescribed and defined daily doses: a matter of patients or drug classes? Eur J Clin Pharmacol. 2011 Aug; 67(8): 847-54. doi:10.1007/s00228-011-1014-7.
23. Manan MM, Baharuddin AY, Lean QY, Dhaliwal J, Dhaliwal SKS, Farrukh MJ, et al. Comparison of the factors that influence the pattern of procurement and usage of antithrombotic drugs. Prog Microbes Mol Biol. 2022; 5(1).
24. Venkateshwarlu K, Jacinth TPJ, Praneeth G, Anusha G, Rahul Goud N. Calculation of prescribed daily dose of anticoagulants in South Indian population. Asian J Pharm Clin Res. 2018; 11(6): 158-61.
25. Adelborg K, Grove EL, Sundbøll J, Laursen M, Schmidt M. Sixteen-year nationwide trends in antithrombotic drug use in Denmark and its correlation with landmark studies. Heart. 2016 Dec 1; 102(23): 1883-9.
26. Shields LBE, Fowler P, Siemens DM, et al. Standardized warfarin monitoring decreases adverse drug reactions. BMC Fam Pract. 2019; 20: 151.
27. Vojacek J. Clinical monitoring of the antithrombotic treatment. Cor Vasa. 2012; 54(2): e97-e103.
28. Paquette M, Fadahunsi O, Wang M, Healey JS, Parkash R, Quayyum S, et al. Systematic review of treatment gaps in oral anticoagulant use in atrial fibrillation. Thromb Update. 2021; 4: 100053. doi:10.1016/j.tru.2021.100053.
29. Goto S, Merrill P, Wallentin L, Wojdyla DM, Hanna M, Avezum A, et al. Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrial fibrillation: insights from Aristotle. Eur Heart J Cardiovasc Pharmacother. 2018 Apr; 4(2): 75-81. doi:10.1093/ehjcvp/pvy002.
30. Van Edom CJ, Swol J, Castelein T, Gramegna M, Huber K, Leonardi S, et al. European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: a survey. Eur Heart J Acute Cardiovasc Care. 2024 Jun 30; 13(6): 458-69. doi:10.1093/ehjacc/zuae040.
31. Huisman MV, Rothman KJ, Paquette M, Teutsch C, Diener HC, Dubner SJ, et al. Antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation: the GLORIA-AF registry, phase II. Am J Med. 2015 Dec; 128(12): 1306-13.e1. doi:10.1016/j.amjmed.2015.07.013.
32. Xiang Y, Zhao H, Ding C, Chen H, Wang D, Liu A. The prophylactic use of tirofiban versus oral antiplatelet medications in stent-assisted coiling of intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol. 2021 Apr; 42(4): 713-9. doi:10.3174/ajnr.A6996.
33. Abrignani MG, Lombardo A, Braschi A, Renda N, Abrignani V, Lombardo RM. Time trends in antithrombotic therapy prescription patterns: real-world monocentric study in hospitalized patients with atrial fibrillation. World J Cardiol. 2022 Nov 26; 14(11): 576-98. doi:10.4330/wjc.v14.i11.576.
34. Vyas S, Dagar W, Dhanawat M, Manzoor S, Gupta S, Das R, et al. Drug utilization analysis of anticoagulant and antiplatelet drugs in the cardiology department of a tertiary care hospital. J Young Pharm. 2022; 14(1): 122-5.
35. Sankhi S, Marasine N, Thapa P, Dc N. Anticoagulant utilization and cost analysis among cardiology inpatients in a tertiary care teaching hospital of Western Nepal. Adv Pharm Pharm Sci. 2020;2020:8890921. doi:10.1155/2020/8890921.
36. Kassere S, Kalra J, Rawat A, Kohli S. Adverse drug reactions monitoring of anticoagulant drugs used in cardiac coronary care unit. Int J Basic Clin Pharmacol. 2019; 8(11): 2512-6. doi:10.18203/2319-2003.ijbcp20194794.
37. Saffian SM, Duffull SB, Wright D. Warfarin dosing algorithms underpredict dose requirements in patients requiring ≥7 mg daily: a systematic review and meta-analysis. Clin Pharmacol Ther. 2017 Aug; 102(2): 297-304. doi:10.1002/cpt.649.
38. Grimmsmann T, Himmel W. Discrepancies between prescribed and defined daily doses: a matter of patients or drug classes? Eur J Clin Pharmacol. 2011 Aug; 67(8): 847-54. doi:10.1007/s00228-011-1014-7.
39. Vinogradova Y, Coupland C, Hill T, Hippisley-Cox J. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ. 2018; 362: k2505.
40. Al-Khatib SM, Pokorney SD, Al-Khalidi HR, Haynes K, Garcia C, Martin D, et al. Underuse of oral anticoagulants in privately insured patients with atrial fibrillation. Am Heart J. 2020 Nov; 229: 110-7.
41. Smythe MA, Priziola J, Dobesh PP, Wirth D, Cuker A, Wittkowsky AK. Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism. J Thromb Thrombolysis. 2016 Jan; 41(1): 165-86. doi:10.1007/s11239-015-1315-2.
42. Peters RJG, Mehta SR, Fox KAA, Zhao F, Lewis BS, Kopecky SL, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the CURE study. Circulation. 2003; 108(14): 1682-7.
43. Heramvand N, Masyuk M, Muessig JM, et al. Pharmacosimulation of delays and interruptions during administration of tirofiban: a systematic comparison between EU and US dosage regimens. J Thromb Thrombolysis. 2022; 54: 301-8. doi:10.1007/s11239-022-02654-0.
44. Rayees NM, Sampath Kumar, Bharath Raj KC, Rajesh KS, Joel JJ, Prasanna Shama K, et al. A prospective observational study on adverse drug reactions in general medicine department of a tertiary care teaching hospital. Res J Pharm Technol. 2019; 12(5): 2289-98. doi:10.5958/0974-360X.2019.00382.2.
45. Apsite K, Pukite K, Tupahins A, et al. Potential drug-drug interactions between oral anticoagulants for high-risk patients with atrial fibrillation in Latvia. Cor Vasa. 2019; 61: e266-e71.
46. Jagadeesan M, Manikandan R, Sri Sai Sudha N. The drug-drug interactions: affecting the rationality of prescriptions. Res J Pharm Technol. 2018; 11(7): 3077-80. doi:10.5958/0974-360X.2018.00565.6.
47. Spandana A, Sri Ranjith A, Vani T, Vinay Kumar T, Yuva Sri Sai A. Assessment and evaluation of drug-drug interactions in ICU of a tertiary care hospital and pharmacist interventions. Res J Pharm Technol. 2019; 12(8): 3613-8. doi:10.5958/0974-360X.2019.00616.4.
48. Biswas AG, Pati RN, Goda J, Begum SS, Kumar A. Evaluation of drug-drug interactions between anticoagulants and antiplatelet agents in cardiovascular patients. Afr J Biomed Res. 2024; 27(3): 486-91.
49. Dunn SP, Macaulay TE. Drug-drug interactions associated with antiplatelet therapy. Cardiovasc Hematol Agents Med Chem. 2011; 9(4): 231-40. doi:10.2174/187152511798120912.
50. Smythe MA, Cuker A, Priziola J, et al. Laboratory and clinical monitoring of direct acting oral anticoagulants: what clinicians need to know. Pharmacotherapy. 2017; 37: 236-48.