Managing Anticoagulation in Special Populations

In this clip, Elizabeth Pogge, PharmD, MPH, BCPS-AQ Cardiology, Associate Professor, Midwestern University College of Pharmacy — Glendale, Glendale, AZ, discusses management of anticoagulation medications in special populations, including pregnant women and elderly individuals. This video was filmed at the 2019 American Society of Health-System Pharmacists (ASHP) Summer Meeting in Boston.

Elizabeth Pogge, PharmD, MPH, BCPS-AQ Cardiology: Anticoagulation in special populations can be really tricky because one of the big issues is that, often times, we don’t have a lot of really good data to support what we need to do with these special populations with clotting [issues] or [that] need anticoagulation.

Some of the things I think about when I think about special populations that need extra special care that we need to really, as pharmacists, get involved with and make sure that we’re helping providers make the right decisions is pregnancy. That can be really tricky. We have problems with the fetus and worrying about adverse effects with the fetus, but also then clotting in the mother. And so adverse outcomes from that standpoint, so that can be really tricky. Pregnancy is an area where, oftentimes, clotting can occur.

Special populations on the other end, thinking about our geriatric population and some of the special things that really affect them. Being on multiple medications. Having reduced renal function and what do we do with them. Are they on the correct dose? And then all the other medications that they’re on. What kind of things do we need to think about?

Comorbidities is such a huge thing. Every patient could be considered their own special population when we look at every person with comorbidities. [When considering] patient-centered care with anticoagulation, pharmacists can really play a key role with that.