Judicious Use of Aspirin specially with Anticoagulation Therapy : Nandita Bhatnagar

 

Judicious Use of Aspirin specially with Anticoagulation Therapy

My work revolves around looking at evaluation and performance data generated from Anticoagulation Clinics (ACC), based on Prothrombin Time (PT)/INR values to manage the Oral Anticoagulation Therapy (OAT). One thing that I always try to keep in mind is that many people these days are taking Aspirin(acetylsalicylic acid) without a clear therapeutic indication. I myself take baby Aspirin every other day and it is over the counter (OTC). Indications for aspirin include primary prevention in those individuals at risk for coronary artery disease (CAD).

Patients often receive warfarin or a direct oral anticoagulant for stroke prevention in atrial fibrillation (AF) and for the treatment and secondary prevention of venous thromboembolic disease (deep vein thrombosis, pulmonary embolism, and venous thromboembolism [VTE]) as well as mechanical heart valves (MHV).Many patients initiating therapy with warfarin are already receiving aspirin, or they subsequently initiate aspirin therapy because of other comorbidities.

Anticoagulation therapy has become fairly complicated these days, specially post Covid-19 pandemic. With so many new drugs and direct thrombin inhibitors in the mix in the prescription panel there are more adverse events being reported than before. It is not uncommon for patients to require multiple antithrombotic medications and is a common clinical scenario.

In a registry-based cohort study of 3688 propensity score–matched patients followed up prospectively at anticoagulation clinics, without a heart valve replacement or recent acute coronary syndrome, 37.5% received aspirin. These patients concurrently using warfarin and aspirin therapy had a statistically higher rate of bleeding, emergency department visits, and hospitalizations for bleeding.

Clinicians should be judicious in selecting patients for combination therapy, and general public should also be careful in ingestion of Aspirin without clinical justification.  An intervention targeted at reducing aspirin use in this population could have profound public health impact.

 

Nandita Bhatnagar

VP of Clinical & Technical Affairs at CoaguSense

San Ramon, California, United States

About

My background is in laboratory medicine starting my career in the Pathology Dept of a 350 bed Hospital & Research Center in India where I co- authored a paper which was presented in the State Clinical Biochemist Association. My work as Chief Microbiologist at a food industry in collaboration with Swedish company Tetrapak, made me recognize my passion for patient care and so I set up a Path Lab with a satellite center for 11 years. I relocated to USA in 2000 and volunteered at BioGenex in providing customer-centric molecular pathology solutions.
I sought out a position with a more direct patient care opportunity working at Cholestech Corporation. I learned the Manufacturing/Vendor Management side of the POC Testing along with managing the Technical Advisors Team at HemoSense Inc. When Cholestech Corp and HemoSense Inc were both acquired by Alere (Previously Inverness Medical) I was kept on board as a valuable asset.
Having enjoyed working in small companies I joined CoaguSense Inc as a Director of Clinical & Technical Affairs and launched the product after successful clinical trials and FDA approval. As a Sr. Dir. Clinical/Technical Affairs I was instrumental in clinical studies, subsequent FDA approval and launch of the 2nd generation smart PT2 Meter.

Apart from the Technical Writing I belong to a Writers Club and had a weekly column in Indian newspaper for few years as well as few publishing’s in Contra Costa Times “Real Life”.

In my free time I volunteer in HSS a social and cultural IRS approved 501c3 tax-exempt non-profit organization.