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Warfarin

S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Aschroft

Type
Drug
ID
PH691
Version ID
1382
Data Sources
Valid event data range
Start - 01/02/2013
Sex
Female, Male
Agreement Date
2015-11-03
Coding system
GPRD product codes
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Study question:

What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices?

Methods:

A cross sectional study included all adult patients potentially at risk of a prescribing or monitoring error defined by a combination of diagnoses and prescriptions in 526 general practices contributing to the Clinical Practice Research Datalink (CPRD) up to 1 April 2013. Primary outcomes were the prevalence of potentially hazardous prescriptions of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives, and oestrogens and monitoring by blood test less frequently than recommended for patients with repeated prescriptions of angiotensin converting enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium, or warfarin.

Study answer and limitations:

49 927 of 949 552 patients at risk triggered at least one prescribing indicator (5.26%, 95% confidence interval 5.21% to 5.30%) and 21 501 of 182 721 (11.8%, 11.6% to 11.9%) triggered at least one monitoring indicator. The prevalence of different types of potentially hazardous prescribing ranged from almost zero to 10.2%, and for inadequate monitoring ranged from 10.4% to 41.9%. Older patients and those prescribed multiple repeat medications had significantly higher risks of triggering a prescribing indicator whereas younger patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. There was high variation between practices for some indicators. Though prescribing safety indicators describe prescribing patterns that can increase the risk of harm to the patient and should generally be avoided, there will always be exceptions where the indicator is clinically justified. Furthermore there is the possibility that some information is not captured by CPRD for some practices—for example, INR results in patients receiving warfarin.

What this study adds:

The high prevalence for certain indicators emphasises existing prescribing risks and the need for their appropriate consideration within primary care, particularly for older patients and those taking multiple medications. The high variation between practices indicates potential for improvement through targeted practice level intervention.

Publications

  • S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Ashcroft, Examining variations in prescribing safety in UK general practice cross sectional study using the Clinical Practice Research Datalink. BMJ, 351(h5501), 2015.

Clinical Code List

Rows: 58
Code Description Coding System (CPRD_product_code) Entity type Category
13348 Marevan 5mg tablets (AMCo) CPRD_product_code res25: warfarin drug
1781 Warfarin 5mg tablets CPRD_product_code res25: warfarin drug
17965 Marevan 500microgram tablets (AMCo) CPRD_product_code res25: warfarin drug
23078 Warfarin 1mg Tablet (WB Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
30202 Warfarin wbp 1mg Tablet (Boehringer Ingelheim Ltd) CPRD_product_code res25: warfarin drug
30203 Warfarin wbp 3mg Tablet (Boehringer Ingelheim Ltd) CPRD_product_code res25: warfarin drug
31511 Warfarin 3mg Tablet (WB Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
31937 Warfarin 5mg tablets (Teva UK Ltd) CPRD_product_code res25: warfarin drug
33711 Warfarin 5mg Tablet (WB Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
34019 Warfarin 1mg tablets (IVAX Pharmaceuticals UK Ltd) CPRD_product_code res25: warfarin drug
34086 Warfarin 3mg Tablet (Celltech Pharma Europe Ltd) CPRD_product_code res25: warfarin drug
34087 Warfarin 1mg Tablet (Celltech Pharma Europe Ltd) CPRD_product_code res25: warfarin drug
34088 Warfarin 5mg Tablet (Celltech Pharma Europe Ltd) CPRD_product_code res25: warfarin drug
34095 Warfarin wbp 5mg Tablet (Boehringer Ingelheim Ltd) CPRD_product_code res25: warfarin drug
34299 Warfarin 1mg tablets (Teva UK Ltd) CPRD_product_code res25: warfarin drug
34416 Warfarin 1mg tablets (Kent Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
34417 Warfarin 3mg tablets (Teva UK Ltd) CPRD_product_code res25: warfarin drug
34418 Warfarin 5mg tablets (Generics (UK) Ltd) CPRD_product_code res25: warfarin drug
34517 Warfarin 1mg tablets (Generics (UK) Ltd) CPRD_product_code res25: warfarin drug
34526 Warfarin 3mg tablets (Generics (UK) Ltd) CPRD_product_code res25: warfarin drug
34576 Warfarin 1mg Tablet (Lagap) CPRD_product_code res25: warfarin drug
34691 Warfarin 5mg Tablet (Regent Laboratories Ltd) CPRD_product_code res25: warfarin drug
34758 Warfarin 3mg tablets (IVAX Pharmaceuticals UK Ltd) CPRD_product_code res25: warfarin drug
34864 Warfarin 5mg tablets (IVAX Pharmaceuticals UK Ltd) CPRD_product_code res25: warfarin drug
34918 Warfarin 5mg tablets (Actavis UK Ltd) CPRD_product_code res25: warfarin drug
36099 Warfarin 1mg/5ml oral suspension CPRD_product_code res25: warfarin drug
38041 Warfarin sodium 5mg/ml oral suspension CPRD_product_code res25: warfarin drug
38044 Warfarin 5mg/5ml oral solution CPRD_product_code res25: warfarin drug
39866 Warfarin 1mg tablets (Almus Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
40143 Warfarin 500microgram tablets (A A H Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
43407 Warfarin 3mg tablets (A A H Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
43408 Warfarin 1mg tablets (A A H Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
43409 Warfarin 5mg tablets (A A H Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
43655 Warfarin sodium oral solution CPRD_product_code res25: warfarin drug
44866 Warfarin sodium 1mg/ml oral supension SF CPRD_product_code res25: warfarin drug
45 Warfarin 1mg tablets CPRD_product_code res25: warfarin drug
47944 Warfarin 1mg tablets (Actavis UK Ltd) CPRD_product_code res25: warfarin drug
48070 Warfarin sodium tablets CPRD_product_code res25: warfarin drug
50000 Warfarin 1mg/ml oral suspension sugar free (A A H Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
51484 Warfarin 1mg tablets (Bristol Laboratories Ltd) CPRD_product_code res25: warfarin drug
51496 Warfarin 1mg tablets (Phoenix Healthcare Distribution Ltd) CPRD_product_code res25: warfarin drug
51509 Warfarin 1mg tablets (APC Pharmaceuticals & Chemicals (Europe) Ltd) CPRD_product_code res25: warfarin drug
53745 Warfarin 3mg tablets (Bristol Laboratories Ltd) CPRD_product_code res25: warfarin drug
53752 Warfarin 1mg tablets (Alliance Healthcare (Distribution) Ltd) CPRD_product_code res25: warfarin drug
54946 Warfarin 3mg tablets (Actavis UK Ltd) CPRD_product_code res25: warfarin drug
55316 Warfarin 3mg/5ml oral suspension CPRD_product_code res25: warfarin drug
56314 Warfarin 3mg tablets (Kent Pharmaceuticals Ltd) CPRD_product_code res25: warfarin drug
58519 Warfarin 1mg tablets (DE Pharmaceuticals) CPRD_product_code res25: warfarin drug
58787 Warfarin 5mg tablets (Alliance Healthcare (Distribution) Ltd) CPRD_product_code res25: warfarin drug
58962 Warfarin 3mg tablets (DE Pharmaceuticals) CPRD_product_code res25: warfarin drug
59400 Warfarin 500microgram tablets (Sigma Pharmaceuticals Plc) CPRD_product_code res25: warfarin drug
59578 Warfarin 3mg tablets (Phoenix Healthcare Distribution Ltd) CPRD_product_code res25: warfarin drug
60589 Warfarin 500microgram tablets (Actavis UK Ltd) CPRD_product_code res25: warfarin drug
61 Warfarin 3mg tablets CPRD_product_code res25: warfarin drug
6262 Warfarin 500microgram tablets CPRD_product_code res25: warfarin drug
833 Warfarin 3mg/5ml oral solution CPRD_product_code res25: warfarin drug
8466 Marevan 1mg tablets (AMCo) CPRD_product_code res25: warfarin drug
8467 Marevan 3mg tablets (AMCo) CPRD_product_code res25: warfarin drug

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH691/version/1382/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH691/version/1382/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH691', '1382', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH691/version/1382/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH691/version/1382/export/codes/?format=json
CSV site_root/phenotypes/PH691/version/1382/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH691', '1382', api_client=client)

Version History

Version
ID
Name Owner Publish date
1382 Warfarin ieuan.scanlon 2021-10-06 currently shown

Export - export all codes into a csv file/JSON/XML for the current phenotype version.

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