Samaritan research on the use of the blood thinner apixaban in patients with larger body mass was recently published in a peer-reviewed journal, Annals of Pharmacotherapy.
The research started as a pharmacy residency project in collaboration with the cardiology fellowship and studied the use of apixaban in people with a body mass index higher than 40 or weight more than 265 pounds. The study came about after a discussion between Cardiologist Jeff Hsing, MD, and Pharmacy Resident Coordinator Jacqueline Joss in the spring of 2019.
“There was not much good evidence on the topic and the use of this medication in this population was a common clinical question,” said Joss.
Blood thinners such as warfarin and direct oral anticoagulants, known as direct-acting oral anticoagulants or DOACs, like apixaban are commonly prescribed to prevent strokes and blood clots in certain patients. Warfarin has been around for a number of years and requires regular visits for blood tests. DOACs are more convenient as they do not require multiple patient visits.
“Warfarin stops the production of clotting factors while DOACs directly inhibit the clotting factors,” explained cardiology fellow Weston Harkness, DO, who helped author the study.
The study collaboration included pharmacy resident Santon Shagavah and cardiology fellow Michael Schiedler, DO, and Biostatistician Olivia Pipitone from Samaritan Health Outcomes Research and Evaluation (SHORE) compiled a list of patients who would qualify for the study. Ryan Moore, pharmacist at the Good Samaritan inpatient pharmacy in Corvallis, contributed to the design of the protocol and manuscript review while Shagavah and Dr. Schiedler created the protocol and patient forms. .
“Dr. Schiedler, Santon and I then began cold calling patients,” Joss said. “We got pretty creative. I did one home visit in Newport to get a patient’s consent. I’ll never forget it. It was pouring down rain and I was standing outside with all my papers.”
When COVID-19 hit, recruitment became more difficult, because of the limits placed on in-person interactions. Each patient in the study had to take two blood tests while using DOACs. “The patients were really excited to participate, though,” said Joss. “They knew it would help them and help others in the future.”
The recruited group, along with patients whose levels had been documented by the ambulatory anticoagulation clinic, made up the study group.
Joss described Dr. Harkness as the “captain” of the manuscript portion of the research when it came time to analyzing and writing up the results.
“I am very proud of the work of Jacqueline and this team did to complete the research and pursue publication on an important clinical dilemma and patient safety issue,” said Dan Rackham, PharmD, chief pharmacy officer.
Part of the pharmacy residency program includes working on a research project. In the past 20 years, Joss’ researchers have had at least three of their projects picked up in national publications.
“I hope we can do more multi-disciplinary research in the future and I really appreciate having the folks from SHORE available for projects like this,” Joss said.
The results of the study have changed cardiology practice within Samaritan.
“Having this information, I’d say the cardiologists are more willing to start someone on apixaban, for sure,” said Dr. Harkness.
Two members of the International Society of Thrombosis and Hemostasis Subcommittee on Anticoagulation also reached out to the research team.
“They were thankful for us providing the data to support what everyone had actually been,” said Dr. Harkness. That committee guides the recommendations for anticoagulant use.
Anticoagulants are commonly prescribed to prevent strokes in patients suffering from atrial fibrillation and blood clots form both deep vein thrombosis and pulmonary embolisms. Some patients are not allowed to take DOACs such as those with mechanical heart valves and patients with certain blood clotting disorders including lupus anticoagulant.