Anis Ali, Heneghan Carl, Aronson Jeffrey K, DeVito Nicholas J, Richards Georgia C
Oxford University Medical School, University of Oxford, Oxford, UK.
Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BJGP Open. 2022 Mar 22;6(1). doi: 10.3399/BJGPO.2021.0150. Print 2022 Mar.
The global burden of cardiovascular disease (CVD) is forecast to increase, and anticoagulants will remain important medicines for its management. Coroners' Prevention of Future Death reports (PFDs) provide valuable insights that may enable safer and more effective use of these agents.
To identify CVD-related PFDs involving anticoagulants.
DESIGN & SETTING: Case series of coronial reports in England and Wales between 2013 and 2019.
A total of 3037 PFDs were screened for eligibility. PFDs were included where CVD and an anticoagulant caused or contributed to the death. Included cases were descriptively analysed and content analysis was used to assess concerns raised by coroners and who had responded to them.
The study identified 113 CVD-related PFDs involving anticoagulants. Warfarin (36%, = 41), enoxaparin (11%, = 12), and rivaroxaban (11%, = 12) were the most common anticoagulants reported. Concerns most frequently raised by coroners included poor systems (31%), poor communication (25%), and failures to keep accurate medical records (25%). These concerns were most often directed to NHS trusts (29%), hospitals (10%), and general practices (8%). Nearly two-thirds (60%) of PFDs had not received responses from such organisations, which are mandatory under regulation 28 of the Coroners' (Investigations) Regulations 2013. A publicly available tool has been created by the authors (https://preventabledeathstracker.net), which displays coroners' reports in England and Wales to streamline access, and identify important lessons to prevent future deaths.
National organisations, healthcare professionals, and prescribers should take actions to address the concerns of coroners in PFDs to improve the safe use of anticoagulants in patients with CVD.
预计心血管疾病（CVD）的全球负担将会增加，抗凝剂仍将是其管理的重要药物。死因裁判官的未来死亡预防报告（PFDs）提供了宝贵的见解，可能有助于更安全、有效地使用这些药物。
识别涉及抗凝剂的与心血管疾病相关的PFDs。
2013年至2019年英格兰和威尔士死因裁判报告的病例系列。
共筛选3037份PFDs以确定其是否符合条件。当心血管疾病和抗凝剂导致或促成死亡时，这些PFDs被纳入。对纳入的病例进行描述性分析，并使用内容分析法评估死因裁判官提出的问题以及对此做出回应的人员。
该研究识别出113份涉及抗凝剂的与心血管疾病相关的PFDs。华法林（36%，n = 41）、依诺肝素（11%，n = 12）和利伐沙班（11%，n = 12）是报告中最常见的抗凝剂。死因裁判官最常提出的问题包括系统不完善（31%）、沟通不畅（25%）以及未能保存准确的医疗记录（25%）。这些问题大多指向国民保健服务信托机构（29%）、医院（10%）和全科诊所（8%）。近三分之二（60%）的PFDs未收到这些组织的回应，而根据2013年《死因裁判官（调查）条例》第28条规定，这些回应是强制性的。作者创建了一个公开可用的工具（https://preventabledeathstracker.net），该工具展示英格兰和威尔士的死因裁判官报告，以简化获取途径，并识别预防未来死亡的重要经验教训。
国家组织、医疗保健专业人员和开处方者应采取行动，解决死因裁判官在PFDs中提出的问题，以改善心血管疾病患者抗凝剂的安全使用。
