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. 2020 Aug;86(8):1567-1574.
doi: 10.1111/bcp.14264. Epub 2020 Mar 13.

Quality of clinical direct oral anticoagulant prescribing and identification of risk factors for inappropriate prescriptions

Zhu Xian Zhang  1 , Ewoudt M W van de Garde  1   2 , Maaike Söhne  3 , Ankie M Harmsze  1 , Marcel P H van den Broek  1
Affiliations

Quality of clinical direct oral anticoagulant prescribing and identification of risk factors for inappropriate prescriptions

Zhu Xian Zhang et al. Br J Clin Pharmacol. 2020 Aug.

Abstract

Aims: Even though the use of direct oral anticoagulants (DOACs) is safe based on clinical outcomes, drug safety also depends on appropriateness of drug prescription, which is challenging for DOACs since many patient factors need to be considered. The aim of this study was to assess the appropriateness of DOAC prescriptions and to identify risk factors of determinants for inappropriate DOAC prescriptions.

Methods: A retrospective study in a nonuniversity teaching hospital was performed of hospitalized patients (≥18 years) who received an initial DOAC prescription between February and August 2018. Appropriateness of prescribing was evaluated on 8 criteria by using a modified version of the medication appropriateness index.

Results: A total of 770 initial DOAC prescriptions of inpatients were evaluated: 267 patients (34.6%) had at least met 1 inappropriate criterion for a DOAC prescription. The most frequent inappropriate criterion was dosage (17.4%). Of the 4 DOACs, dabigatran (21.6%) and apixaban (21.2%) were mostly inappropriate dosed. In a multivariable analysis, reduced renal function (estimated glomerular filtration rate <50 mL/min; odds ratio [OR] = 2.35; P < .001), a diagnosis of atrial fibrillation (OR = 1.87; P = .004), and 'prescribed by surgeons' (OR = 1.9; P = .013) were independently associated with inappropriateness of prescribing.

Conclusion: This study has highlighted a high degree of inappropriate prescribing of DOACs. These results underline the need for targeted interventions to improve DOAC prescribing.

Keywords: DOAC; appropriateness of prescription; medication appropriateness index; medication errors; prescribing patterns.

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Conflict of interest statement

There are no competing interests to declare.

Figures

FIGURE 1
FIGURE 1
Number of inappropriateness prescriptions per independent criterion. VTE, venous thromboembolism
See this image and copyright information in PMC

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