Millions of Americans are taking blood-thinning drugs for common medical conditions. Often, they receive prescriptions for more than one when they have multiple chronic diseases or conditions. As Americans age and the number of people on these drugs is expected to steadily increase over the coming decades, researchers are trying to better understand how the drugs interact with each other.
With an RO1 grant from the Agency for Healthcare Research and Quality, Mayo Clinic researchers are doing exactly that.
Researchers in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery in Arizona will use the grant to explore bleeding risks within certain groups of patients and with specific drug combinations. The grant is for four years, beginning this month, and $1.58 million total.
Blood-thinning drugs are generally either anticoagulants, which lengthen the time it takes to form a blood clot, or antiplatelet drugs, which prevent blood cells called platelets from collecting to form clots. Anticoagulants are often used for atrial fibrillation, an irregular and often rapid heart rate, and venous thromboembolism, a blood clot in a vein – usually in the legs. Antiplatelets are used for conditions such as acute coronary syndrome, which causes decreased blood flow from the heart.
Anticoagulants include apixaban, dabigatran, edoxaban, rivaroxaban and warfarin. Examples of antiplatelets are aspirin, clopidogrel, dipyridamole, prasugrel and ticlopidine. Each of these blood-thinning drugs can cause gastrointestinal bleeding on their own, so researchers say it’s important to know more about what they do when used together.
“Knowing the real-world bleeding risks of these blood-thinners and which patients are most at risk will help health care providers and their patients make informed decisions,” says the grant’s principal investigator, Neena S. Abraham, M.D., a gastroenterologist and health sciences researcher at Mayo Clinic.
The researchers plan to fill this knowledge gap by showing what percentage of patients are at risk for gastrointestinal bleeding based on the presence of individual and combinations of certain factors. Those factors include age, patients with multiple conditions, liver failure and renal failure. The study will also look at the risk of bleeding when blood-thinners are used in combination for atrial fibrillation, acute coronary syndrome or venous thromboembolism.
“Using scientific data and machine learning techniques to predict risk factors and at at-risk groups is the first step in improving outcomes for patients,” Dr. Abraham says.
Dr. Abraham is site director in Arizona of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The center analyzes data with the goal of making broad-based quality and efficiency improvements in patient care at Mayo and beyond.
The center’s research team also has published related studies on the safety and effectiveness of blood-thinning drugs, comparing newer drugs’ risk of bleeding, and health care providers’ prescribing practices, among others.