A Sanford Health study involving patients taking blood thinners is translating to more effective care with less bleeding.
The recent study compared treatment strategies at Sanford hospitals in Sioux Falls, South Dakota, and Fargo, North Dakota, for patients transitioning from one blood thinner to another.
When patients enter the hospital and are already taking a prescription blood thinner pill, they’re often switched to a blood thinner that enters the body via an IV. Customarily, this switch begins when it’s time to take the next dose of the patient’s normal blood thinner.
Managing blood can vary
The science is not always clear on how much of the original blood thinner remains in a patient’s system when the IV is administered, explained Michael Gulseth, Pharm.D., anticoagulation stewardship director at Sanford USD Medical Center.
“When people on blood thinners enter the hospital and are really sick — especially with heart attacks — how we manage that person’s blood can be an open question,” Gulseth said. “How do we determine when to make a switch to a new blood-thinning medication? It’s something that has never been clearly delineated in scientific studies.”
For instance, let’s say an outpatient who is taking Eliquis (apixaban), a common blood thinner, has chest pain and comes to the hospital. They are diagnosed with a minor heart attack and are admitted for observation. The patient would be taken off Eliquis and transitioned to heparin, which is administered by IV.
Using the guidelines established in the study, providers can optimize treatment to assure this process does not lead to the heart attack getting worse or cause bleeding.
“We were lucky enough that there were a couple different approaches being taken here in Sioux Falls and in Fargo,” Gulseth said. “Neither one was necessarily right or wrong but it gave us a really nice scientific window where we could compare them and see if one was better than the other. There really hasn’t been anything done like this anywhere in the world.”
More effective monitoring
The amount of heparin necessary can vary by individual. This means that after patients are connected to an IV drip, the heparin level needs to be fine-tuned.
The most common lab tests for monitoring heparin levels are what is called activated partial thromboplastin time (aPTT) and the antifactor Xa heparin assay. In Fargo, the aPTT was used. In Sioux Falls, the antifactor Xa heparin assay was used.
Ultimately, the study aimed at determining the most effective means of monitoring heparin when patients are transitioning from common blood thinning pills. An important step in accomplishing that is measuring the amount of anticoagulant that is already in a patient’s system.
In the study, the monitoring approach used in Sioux Falls proved to be at least as effective as the alternative approach, with possibly less bleeding.
“We were able to show that our process works,” Gulseth said. “If anything it could lead to less bleeding, which is exactly what we expected. We used the study to validate our process. Fargo is now moving their practices to be more similar to what we’re doing.”
In one sense, the study served to demonstrate how Sanford skillfully handles blood thinner transitions. It also highlighted the expertise that accompanies quality research and leads to better patient outcomes.
“The study helped to validate our practice and it also helped to validate a guideline for clinical pharmacists and physicians to manage the transition of anticoagulants,” Gulseth said. “It gives us the opportunity to give this knowledge to everyone. Not only have we improved patient care here at Sanford, we feel like this work can improve care of patients throughout the world.”