ABSTRACT
Introduction: The use of antidepressants seems to be increasing in most countries worldwide, probably due to the increasing burden of stressful life (1). Apart from their therapeutic application, antidepressants are sometimes used as lifestyle drugs. Monitoring antidepressant usage is crucial to prevent unnecessary consumption and avoid adverse effects and additional costs (2). Objectives: The aim of this work was to study trends in antidepressants utilization in various European countries, and to note changes in their usage between the years 2013 and 2019, before the outbreak of COVID 19 pandemic. Methods: Data on antidepressants consumption in 20 European countries were collected from the Organization for Economic Cooperation and Development (OECD) data bases. Antidepressants consumption was expressed in Defined Daily Doses (DDDs) per 1,000 inhabitants per day, and calculations referred to years 2013 and 2019. Changes in antidepressants use during this six-year period in each European country were assessed. The statistical package SPSS (Chicago, IL, USA) was used for calculations. Results: There was a huge variation in antidepressants usage among the 20 countries of our study. The mean consumption of antidepressants was 52.67 DDDs per 1,000 inhabitants per day in 2013 (range 10.2-113.7 DDDs) and 62.51 DDDs per 1,000 inhabitants per day in 2019 (range 17.6-146.0 DDDs), with a mean increase of 9.84 DDDs per 1,000 inhabitants per day (18.68%) in just six years. The countries with the highest consumption of antidepressants in 2013 were Iceland (113.7 DDDs), Portugal (87.5 DDDs), Sweden (84.3 DDDs), Belgium (72.1 DDDs), Finland (69.4 DDDs) and Spain (65.2 DDDs). The countries with the highest consumption of antidepressants in 2019 were Iceland (146.0 DDDs), Portugal (123.7 DDDs), Sweden (102.7 DDDs), Spain (83.6 DDDs) and Belgium (81.9 DDDs). The countries with the lowest consumption of antidepressants in 2013 were Latvia (10.2 DDDs), Estonia (21.4 DDDs), Lithuania (24.7 DDDs), and Hungary (27,5 DDDs). The countries with the lowest consumption of antidepressants in 2019 were Latvia (17.6 DDDs), Hungary (29.5 DDDs), Estonia (34,8 DDDs) and Lithuania (35,4 DDDs). The use of antidepressants was increased in all European countries in the study period. There was only one exception: Finland, being one the countries with the highest consumption of antidepressants, reduced their use by 13%. In the countries with the lowest consumption of antidepressants (Latvia, Estonia and Lithuania), the increase in antidepressants usage was higher than 40%. A similarly high increase (41.37%) was also observed in Portugal, which was second in antidepressant use in both years studied (2013 and 2019). The Countries with the lowest increase (less than 5%) were Austria, Norway and Luxemburg, which displayed an average consumption of antidepressants in the study period. Conclusion: There was a huge variation in antidepressants use among the 20 European countries of our study. A trend for increase in antidepressants use was observed in almost all countries during the six-year study period.
ABSTRACT
Introduction: Low molecular weight heparins are used extensively in anticoagulant therapy, due to their safer profile, in comparison to other anticoagulants. Direct Oral AntiCogulants (DOACs) have been initiated in anticoagulant therapy as a safer treatment choice than coumarin derivatives. Objectives: The aim of this study was to investigate the use of oral and injectable anticoagulants, and especially the place of DOACs in anticoagulant treatment, in a tertiary Hospital of Thessaloniki, Greece. Methods: The data were collected by investigating prescriptions from the Hospital Pharmacy of a tertiary Hospital in Thessaloniki, Greece. Prescriptions of oral and injectable anticoagulants for hospitalized patients were collected during the period from June to September 2021. The consumption of the following oral and injectable anticoagulants was recorded in DDDs: acenocumarol, rivaroxaban, apixaban, dabigatran, heparin, enoxaparin, tinzaparin, bemiparin and fondaparinux. Results: The total amount of anticoagulants used was 53,041 DDDs, of which 97,9% were injectable anticoagulants whereas 2,1% were oral anticoagulants. DOACs represented the 1,8% of the anticoagulants used. The consumption of injectable anticoagulants for the hospitalized patients was 51,936 DDDs, of which 63.5% was enoxaparin, 18.5% was tinzaparin, 6.3% was heparin, 6.1% was bemiparin, and 5.6% was fondaparinux. The consumption of acenocumarol was 176 DDDs and the consumption of DOACs was 929 DDDs, with the percentage of rivaroxaban, apixaban, and dabigatran being 46%, 45% and 9% respectively. Indications with the highest prevalence for patients on enoxaparin was COVID 19, heart failure, stroke, angina pectoris, malignancy. Indications with the highest prevalence for patients on tinzaparin was COVID 19, malignancy, stroke. Indications with the highest prevalence for patients on bemiparin was malignancy, COVID 19, aortic valve disease, stroke. Heart failure, stroke and atrial fibrillation were the indications with highest prevalence in patients on DOACs. Acenocumarol was used mainly for heart failure, stroke and aortic valve stenosis. Conclusion: Injectable anticoagulants, and mainly low molecular weight heparins were the treatment of choice in hospitalized patients. Oral anticoagulants represented only a very small proportion (2,1%) of the anticoagulants used. DOACs have replaced coumarin derivatives, representing the 86% of oral anticoagulants in clinical use. Nevertheless, the percentage of DOACs was very low (1.8%) in the total consumption of anticoagulants, with rivaroxaban and apixaban being the most commonly used DOACs. Injectable anticoagulants, especially enoxaparin, are preferred by the clinicians as a safer choice for managing high risk thrombosis in hospitalized patients. DOACs, Direct Oral AntiCogulants, anticoagulants, NOACs.
ABSTRACT
Introduction: The European Open Platform for Prescribing Education (EurOP2E) aims to improve and harmonize European clinical pharmacology and therapeutics education by facilitating international collaboration and sharing open educational resources. The COVID-19 pandemic has forced teachers to switch to online teaching, highlighting the need for high-quality online teaching materials. Objectives: The goal of this study was to establish the resources needed to sustain prescribing education during the pandemic and thereafter. Methods: A nominal group technique study was conducted with prescribing teachers from several European countries and combined with thematic analysis. Results: In four meetings, 20 teachers from 15 countries ranked 35 teaching materials. Ten themes were identified: prescribing scenarios;interactivity & gamification;re-usable materials;online case discussions;practical aspects of prescribing;teaching the teacher;knowledge multimedia;topical issues;personalized & evidence-based prescribing;and essential formularies. Conclusion: By making teaching materials related to the learning outcomes of CPT, format of teaching and resource and faculty development openly available, EurOP2E will help to make high-quality prescribing education available to all. The role of the platform will range from facilitating collaboration to educating the teachers and/or providing ready-touse teaching materials.