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

Autor: Zhang ZX; Department of Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands., van de Garde EMW; Department of Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands.; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands., Söhne M; Department of Internal Medicine, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands., Harmsze AM; Department of Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands., van den Broek MPH; Department of Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands.
Jazyk: angličtina
Zdroj: British journal of clinical pharmacology [Br J Clin Pharmacol] 2020 Aug; Vol. 86 (8), pp. 1567-1574. Date of Electronic Publication: 2020 Mar 13.
DOI: 10.1111/bcp.14264
Abstrakt: 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.
(© 2020 The British Pharmacological Society.)
Databáze: MEDLINE
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