*MEDICATION* Anticoagulation

speed-vm commented 7 months ago

User requirements

Codelist for anticoagulation that could be prescribed in primary care for the treatment and prevention of VTE. This will include oral and parenteral anticoagulants. This will be used together with VTE diagnosis codes to determine incident and prevalent VTE cases.

Sensitivity versus specificity

We will use medications most likely to be used for therapeutic anticoagulation for treatment and prevention of VTE. We will not extract medications that would only be used in a secondary care setting (eg. argatroban and unfractionated heparin)

Relevant definitions or links to important reference sources

No response

Coding system

dm+d

Existing relevant codelists

No response

Search terms / synonyms / search strategy

Anticoagulation and VTMs for codelist

Low molecular weight heparins 775768002 enoxaparin 775440000 dalteparin 777776004 tinzaparin Bemiparin not used in UK

Alternative to LMWH likely low usage 35312611000001107 Fondaparinux sodium (not 1.5mg)

Vitamin K antagonists 777947006 warfarin 774409003 acenocoumarol 777163004 phenindione

Direct oral anticoagulants 777455008 rivaroxaban (Not 2.5mg) 774624002 apixaban 775732007 edoxaban 13568411000001103 dabigatran

Inclusion criteria for codes

No response

Exclusion criteria for codes

2.5mg rivaroxaban 1.5mg fondaparinux

Borderline cases

Bemiparin not used in UK Unfractionated heparin not included as use is in secondary care

Final codelist

No response

Jongmassey commented 7 months ago

Should we include orals in this? There are already oral codelists for anticoagulants. If they are correct then if we made this just a parenterals list then researchers could use/combine both for comprehensive coverage?

Jongmassey commented 7 months ago

Bemiparin not used in UK

AFAICT from the normalised_prescribing table on BQ there were a handful in 2010 but nothing since

speed-vm commented 7 months ago

Yes good idea to do parenteral for future use

speed-vm commented 7 months ago

Need to just double check those non warfarin, vitamin K antagonists included though

Jongmassey commented 7 months ago

From my work on codelist rot I'm leaning to prefer multiple, small codelists with clear purposes rather than large ones that serve multiple purposes

matthewberesford92 commented 6 months ago

thanks @Jongmassey @speed-vm Have split oral/parenteral

https://www.opencodelists.org/codelist/user/matthewberesford92/oral-anticoagulation-used-for-treatment-of-vte-in-primary-care-uk-dmd-dmd/316ca70a/ https://www.opencodelists.org/codelist/user/matthewberesford92/anticoagulation-taken-for-vte-dmd/638b8d74/

Can you clarify why you excluded fonda 1.5mg (i am sure I have used this for prophylaxis ?)

Can you clarify why you excluded rivaroxaban 1.5mg

speed-vm commented 6 months ago

@matthewberesford92 Thank you Fonda 1.5 not included as trying to capture treatment doses rather than thromboprophylaxis. Riva 2.5 used for prophylaxis of atherothrombotic events. Dose would never be appropriate as a treatment for VTE.

speed-vm commented 6 months ago

@matthewberesford92 I have reviewed the Oral Anticoagulation codelist. I am happy with it, so please add my review to your codelist in the review section.

https://www.opencodelists.org/codelist/user/matthewberesford92/oral-anticoagulation-used-for-treatment-of-vte-in-primary-care-uk-dmd-dmd/316ca70a/

speed-vm commented 6 months ago

@matthewberesford92 Two comments for the parenteral anticoagulation codelist. 1) I think its catching, please can you change title to Parenteral rather than parental 2) Please remove this one Arixtra 1.5mg/0.3ml solution for injection pre-filled syringes (AMP) (13565111000001103)

Otherwise I am happy with that codelist. Thank you

Jongmassey commented 6 months ago

You both are the clinical domain experts here but as far as I can see there's no obvious errors

speed-vm commented 4 months ago

@matthewberesford92 when you have time these codelists need my 'sign off' adding to the bottom, and then publishing (they still say under review)

https://www.opencodelists.org/codelist/user/matthewberesford92/oral-anticoagulation-used-for-treatment-of-vte-in-primary-care-uk-dmd-dmd/316ca70a/ https://www.opencodelists.org/codelist/user/matthewberesford92/anticoagulation-taken-for-vte-dmd/638b8d74/

matthewberesford92 commented 4 months ago

sorry @speed-vm, didnt realise I hadnt published.Here they are.

For reference @acagreen17 @joshuamutio

https://www.opencodelists.org/codelist/user/matthewberesford92/anticoagulation-taken-for-vte/79218d24/ https://www.opencodelists.org/codelist/user/matthewberesford92/oral-anticoagulation-used-for-treatment-of-vte-in-primary-care-uk-dmd/4a7c1a3f/

opensafely / codelist-development