Finding answers to questions which have never been asked

Photograph of Jamie Bellinge
March 27, 2018

There’s no doubt undertaking first-in-the-world medical research is a rare and unique opportunity.

For Royal Perth Hospital PhD candidate Dr Jamie Bellinge it was his introduction to the world of unanswered questions as he undertook a retrospective study of 609 patients.

These patients had all been hospitalised in the past two years with either an irregular heart rhythm known as atrial fibrillation, or a blood clot somewhere else in their body.

In addition, they had either been prescribed one of two blood thinner medications to either treat the blood clot, or prevent a stroke occurring from a blood clot in the heart. One of the blood thinners is new whilst the other blood thinner is much older and needs frequent blood tests to monitor its levels. In people living in rural areas, frequent blood tests may be inconvenient.

“We set out to firstly see whether remoteness of people living in WA was likely to impact on their doctor’s tendency to prescribe blood thinners, and if so, whether there was a preference as to which blood thinner their doctor prescribed,” Dr Bellinge said. “One of the blood thinners is newer and we don’t know how they perform in the more rural areas of Australia, where healthcare can be more challenging.”

“We then investigated whether there was any substantial evidence to indicate from the two patient groups prescribed blood thinners if one group was more likely than the other group to experience a medication related bleeding event. This is a feared complication of being treated with blood thinners.”

Dr Bellinge said people with atrial fibrillation are at a high risk of strokes, because blood clots form in the heart, and travel to the brain.

“Prescribing blood thinners can dramatically reduce the risk of stroke in people with atrial fibrillation, but at the same time, thinners can also increase the risk of fatal bleeding.

“Therefore, it becomes important to compare the benefits vs the risks of blood thinners.”

The researchers found that the newer blood thinners were being prescribed more frequently than the older blood thinner, for the prevention of stroke. They also found that people living further away tended to be prescribed the newer blood thinners, that didn’t need frequent blood tests.

“This suggests that the newer blood thinners are becoming more favourable in the rural and remote areas, which is promising, because the risk of bleeding with these new blood thinners is lower. We also found that people on the newer blood thinners had fewer bleeding problems, though it is difficult to draw conclusions on this finding.”

This research has shown that our use of blood thinners in rural areas is improving, and this improvement may be attributable to the increasing acceptance of the newer blood thinners.

This is the first study of its kind to include rural and remote patients in Australia. The study results were published in the Medical Journal of Australia.