Polymedication in sodium warfarin users of the Public Health System and associated variables
Article Sidebar
Main Article Content
Abstract
Objective: To verify the use of polymedication in warfarin users and its association with clinical variables. Methods: cross-sectional study, with warfarin users, of both sexes. For data collection, a structured questionnaire was used, with open and closed questions, on socioeconomic, clinical data and aspects related to pharmacotherapy (adverse reactions, drug interactions, systemic blood pressure indexes, fasting glucose values, self-medication practice, overweight, bleeding episodes and thromboembolism). Results: the average age of the participants was 69.1 ± 13.6 years, mostly female (64.6%), married (43.8%), and white (85.4%). As for education, 41.7% attended incomplete elementary school. Polymedicated patients totaled 89.6%, and patients using ten or more medications, 31.3%. The average number of medications per patient was 8.2 ± 3.5. There was an association between polymedication, occurrence of adverse reactions (94.7% vs 5.3%; p = 0.042) and the number of potential drug interactions, total (8.9 ± 5.0 vs 1.2 ± 1.6; p = 0.001) and severe (3.1 ± 2.4 vs 0.4 ± 0.6; p = 0.017). The other variables studied were not associated with polymedication. Conclusion: the results showed negative interference from polymedication in the occurrence of adverse reactions, and in the potential total and serious drug interactions. There is a need to know the impact of these variables on the polymedicated anticoagulated patient to plan risk reduction strategies and to optimize benefits.
Article Details
Authors maintain copyright and grant the HSJ the right to first publication. From 2024, the publications wiil be licensed under Attribution 4.0 International 
, allowing their sharing, recognizing the authorship and initial publication in this journal.
Authors are authorized to assume additional contracts separately for the non-exclusive distribution of the version of the work published in this journal (e.g., publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.
Authors are encouraged to publish and distribute their work online (e.g., in institutional repositories or on their personal page) at any point after the editorial process.
Also, the AUTHOR is informed and consents that the HSJ can incorporate his article into existing or future scientific databases and indexers, under the conditions defined by the latter at all times, which will involve, at least, the possibility that the holders of these databases can perform the following actions on the article.
References
Almeida, FDM. Relação entre polimedicação e qualidade de vida em idosos do município de Palhoça, Santa Catarina, Brasil [Trabalho de Conclusão de Curso de Medicina]. Pedra Branca: UNISUL; 2018. Avaiable from: www.riuni.unisul.br/handle/12345/5310
Dantas M, Santos V. Implicancias de la polifarmacia en personas mayores y la contribución de la atención farmacéutica. Lecturas: Educación Física y Deportes [Internet]. 2018 [cited 2020 Apr 29];23(240):87-9. Avaiable from: www.efdeportes.com/efdeportes/index.php/EFDeportes/article/view/273/173
Saum KU, Schöttker B, Meid AD , Holleczek B, Haefeli WE, Hauer K, et al. Is polypharmacy associated with frailty in older people? Results from the ESTHER cohort study. J Am Geriatr Soc. 2017;65(2):e27-e32. doi: 10.1111/jgs.14718
Payne RA, Avery AJ, Duerden M, Saunders CL, Simpson CR, Abel GA. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol. 2014;70(5):575-81. doi: 10.1007/s00228-013-1639-9
Katzung, BG, Trevor AJ, editors. Farmacologia básica e clínica 13ª ed. Porto Alegre: AMGH, 2017.
Baglin TP, Cousins D, Keeling DM, Perry DJ, Watson HG. Recommendations from the British Committee for Standards in Haematology and National Patient Safety Agency. Br J Haematol. 2007;136(1):26-9. doi: 10.1111/j.1365-2141.2006.06379.x
Rang H P, Dale M M, Ritter J M, Flower R J, Henderson G, editors. Farmacologia. 7a. ed. Elsevier; 2012.
Pelegrino FM, Dantas RAS, Corbi ISA, Carvalho ARS, Filho AP, Schmidt A. Perfil sócio demográfico e clínico de pacientes em uso de anticoagulantes orais. Rev Gaúcha Enferm. 2010;31(1):123-28. doi: 10.1590/S1983-14472010000100017
Eggebrecht L, Nagler M, Göbel S, Lamparter H, Keller K, Wagner B, et al. Relevance of Polypharmacy for Clinical Outcome in Patients Receiving Vitamin K Antagonists. J Am Geriatr Soc. 2019;67(3):463–70. doi: 10.1111/jgs.15712
Ministério da Saúde (Brasil). Cuidado farmacêutico na atenção básica, Caderno 2: capacitação para implantação dos serviços de clínica farmacêutica. Brasília: Ministério da Saúde; 2014 [cited 2020 Apr 29]. Avaiable from: bvsms.saude.gov.br/bvs/publicacoes/cuidado_farmaceutico_atencao_basica_saude_2.pdf
IBM Micromedex® [Internet]. Micromedex solutions Drug Interactions [cited 2020 Apr 28]. Avaiable from: https://www.micromedexsolutions.com/home/dispatch
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC geriatrics. 2017;17:230. Doi: 10.1186/s12877-017-0621-2
World Health Organization. Global report on diabetes [Internet]. Geneva; 2016 [cited 2020 Apr 28]. Avaiable from: apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf
Malachias MVB, Souza WKSB, Plavnik FL, Rodrigues CIS, Brandão AA, Neves MFT, et al. 7ª Diretriz brasileira de hipertensão arterial. Arq Bras Cardiol [Internet]. 2016 [cited 2020 Apr 28];107(3Supl. 3):1-83. Disponível em: http://publicacoes.cardiol.br/2014/diretrizes/2016/05_HIPERTENSAO_ARTERIAL.pdf
Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica [Internet]. Diretrizes Brasileiras de Obesidade. 4ª Edição. São Paulo; 2016 [cited 2020 Apr 28]. Disponível em: abeso.org.br/wp-content/uploads/2019/12/Diretrizes-Download-Diretrizes-Brasileiras-de-Obesidade-2016.pdf
Souza TF, Colet CF, Heineck I. Knowledge and information levels and adherence to oral anticoagulant therapy with warfarin in patients attending primary health care services. J Vasc Br. 2018;17(2):109–16. doi: 10.1590/1677-5449.012017
Serra IDCC, Ribeiro LDC, Nobre A, Gemito MLGP, Mendes FRP. Gestão terapêutica dos utentes com terapia anticoagulante oral. Enfermería Global [Internet]. 2016 [cited 2020 Apr 28];41:20-29. Avaiable from: scielo.isciii.es/pdf/eg/v15n41/pt_clinica2.pdf
Simonetti SH, Mancussi AC, Bianchi ERF. Preditores clínicos intervenientes na adesão de usuários de anticoagulante orais. Enferm Foco. 2019;10(1):2-6. doi: 10.21675/2357-707X.2019.v10.n1.1359
Menezes GODD, Malveira ASC, Lima JPDS, Prado R MDS, Vasconcelos LMDO. Perfil de utilização da varfarina em pacientes atendidos na farmácia básica da Secretaria de Saúde do Município de Quixeramobim–CE [Abstract]. Anais da Mostra Científica de Farmácia. 2014 [cited 2020 Apr 28]. Avaiable from: 201.20.115.105/home/bitstream/123456789/894/1/4-22-1-PB.pdf
Galato D, Silva ES, Tiburcio LS. Estudo de utilização de medicamentos em idosos residentes em uma cidade do sul de Santa Catarina (Brasil): um olhar sobre a polimedicação. Ciênc Saúde Coletiva. 2010;15(6):2899–905. doi: 10.1590/S1413-81232010000600027
Kichou B, Henine N, Himeur Y, Kichou L, Ait Said M, Mazeghrane A, et al. Assessment of adherence to antihypertensive drugs in patients with resistant hypertension receiving optimal treatment. Ann Cardiol Angeiol (Paris). 2019;68(4):264-8. doi: 10.1016/j.ancard.2019.07.002
Souza MM, Viudes A, Araujo M, Costa JM, Pérez Nunes CMP. identificação de interações medicamentosas e eventos hemorrágicos em idosos em uso de varfarina. revista de atenção primaria a saúde. Rev APS. 2017;20(4):592-601. doi: 10.34019/1809-8363.2017.v20.16244
Instituto Brasileiro de Geografia e Estatística (IBGE), Brasil [Internet]. Número de idosos cresce 18% em 5 anos e ultrapassa 30 milhões em 2017. Brasília: IBGE; 2018 Apr 26 [cited 2020 Apr 29]. Avaiable from: agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/20980-numero-de-idosos-cresce-18-em-5-anos-e-ultrapassa-30-milhoes-em-2017
Machado, TAC. Identificação das potenciais interações medicamentosas com a varfarina e as intervenções do farmacêutico para o manejo de pacientes internados em um hospital universitário [Dissertação de Mestrado]. Porto Alegre: Universidade Federal do Rio Grande do Sul, Faculdade De Farmácia, Programa de Pós-Graduação em Ciências Farmacêuticas; 2011 [cited 2020 Apr 29]. Avaiable from: hdl.handle.net/10183/36115
Arai S, Ishikawa T, Kato H, Koshizaka M, Maezawa Y, Nakamura T, et al. Multidrug use positively correlates with high-risk prescriptions in the Japanese elderly: a longitudinal study. J Pharm Health Care Sci. 2019;5:20. doi: 10.1186/s40780-019-0150-6
Cuentro V, Modesto T, Andrade M, Silva M. prevalência e fatores associados à polifarmácia entre idosos de um hospital público. RCS. 2016;16(30):28-35. doi: 10.21527/2176-7114.2016.30.28-35
Tatro SD. Drug Interaction Facts: the authority on drug interactions. Facts & Comparisons. Philadelphia: Lippincott Williams & Wilkins, 2013.
Teles JS, Fukuda EY, Feder D. Warfarin: pharmacological profile and drug interactions with antidepressants. Einstein (São Paulo). 2012;10(1):110–5. doi: 10.1590/S1679-45082012000100024
Abdel‐Aziz MI, Ali MAS, Hassan AK, Elfaham TH. Warfarin‐drug interactions: An emphasis on influence of polypharmacy and high doses of amoxicillin/clavulanate. J Clin Pharmacol. 2016;56(1):39-46. doi: 10.1002/jcph.583
Moreira D, Medina B, Alves AC, Barroso C, Meneghelo Z, Leporace I, et al. Qual o impacto da polifarmácia sobre a taxa de anticoagulação em paciente em uso de varfarina ? XXXVII Congresso da Sociedade de Cardiologia do Estado de São Paulo; 2016 [cited 2020 Apr 29]; São Paulo, SP. Avaiable from: www.socesp2016.com.br/trabalho/resumo/1541
Sevestre MA. Capsule Commentary on Leiss et al., Polypharmacy is associated with an increased risk of bleeding in elderly patients with venous thromboembolism. J Gen Int Med. 2015, 30:92. doi: 10.1007/s11606-014-3000-0
Ames KS, Bassani Ph, Motter N, Roratto B, Hammes Jln, Quadro MN, et al. Avaliação de hipertensos e diabéticos usuários de polimedicação em Santo Ângelo/RS. Rev Saúde Integr [Internet]. 2016 [cited 2020 Apr 29];9(17):58-65. Avaiable from: local.cnecsan.edu.br/revista/index.php/saude/article/view/306
Ramos LR, Tavares NUL, Bertoldi AD, Farias MR, Oliveira MA, Luiza VL, et al. Polifarmácia e polimorbidade em idosos no Brasil: um desafio em saúde pública. Rev Saude Publica. 2016;50(supl 2):9s. doi: 10.1590/S1518-8787.2016050006145
Almeida OP, Ratto L, Garrido R, Tamai S. Risk factors and consequences of polypharmacy among elderly outpatients of a mental health service. Braz J Psychiatr. 1999;21(3):152-7. doi: 10.1590/S1516-44461999000300006
Bernardes JFP. Etiologia da tontura no idoso: uma perspetiva multifatorial [Dissertação de Mestrado Integrado]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2014 [cited 2020 Apr 29]. Avaiable from: estudogeral.uc.pt/bitstream/10316/31875/1/tese.pdf
Marques LP, Schneider IJC, Giehl MWC, Antes DL, OrsiE. Demographic, health conditions, and lifestyle factors associated with urinary incontinence in elderly from Florianópolis, Santa Catarina, Brazil. Rev Bras Epidemiol. 2015;18(3):595-606. doi: 10.1590/1980-5497201500030006
Marevan: varfarina [Bula de medicamento na Internet]. Responsável técnico Marcia Weiss I. Campos. Rio de janeiro: Farmoquímica S/A; 2020 [cited 2020 Fev 08]. Avaiable from: static-webv8.jet.com.br/drogaosuper/Bulas/7898040320928.pdf
Woźniak I, Kolonko A, Chudek J, Nowak Ł, Farnik M, Więcek A. influence of polypharmacy on the quality of life in stable kidney transplant recipients. Transplant Proc. 2018;50(6):1896–9. doi: 10.1016/j.transproceed.2018.02.128
Granger CB, Alexander JH, McMurray JJV, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92. doi: 10.1056/NEJMoa1107039
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91. doi: 10.1056/NEJMoa1009638
WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical Classification - ATC / DDD Index 2020 [Internet]. 2020 [cited 2020 Apr 29]. Avaiable from: www.whocc.no/atc_ddd_index/