| Autor: |
Moudallel, Souad, Cornu, Pieter, Dupont, Alain, Steurbaut, Stephane |
| Předmět: |
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| Zdroj: |
British Journal of Clinical Pharmacology; Feb2022, Vol. 88 Issue 2, p753-763, 11p |
| Abstrakt: |
Aims: To analyse the appropriateness of direct oral anticoagulant (DOAC) dosing and determinants for under‐and overdosing as well as acceptance and implementation rates of pharmacists' interventions. Methods: Cross‐sectional study in a tertiary hospital in hospitalized patients with atrial fibrillation on DOACs in 2019 (n = 1688). Primary outcome was the proportion of patients with inappropriate DOAC prescribing with identification of determinants for under‐and overdosing. Secondary outcomes included acceptance and implementation rates of pharmacists' recommendations and determination of reasons for nonacceptance/nonimplementation. Results: Inappropriate prescribing was observed in 16.9% of patients (n = 286) with underdosing (9.7%) being more prevalent than overdosing (6.9%). For all DOACs considered together, body weight<60 kg (odds ratio [OR] 0.46 [0.27–0.77]), edoxaban use (OR 0.42 [0.24–0.74]), undergoing surgery (OR 0.57 [0.37–0.87]) and being DOAC naïve (OR 0.45 [0.29–0.71]) were associated with significantly lower odds of underdosing. Bleeding history (OR 1.86 [1.24–2.80]) and narcotic use (OR 1.67 [1.13–2.46]) were associated with significantly higher odds for underdosing. Determinants with a significantly higher odds of overdosing were renal impairment (OR 11.29 [6.23–20.45]) and body weight<60 kg (OR 2.34 [1.42–3.85]), whereas dabigatran use (OR 0.24 [0.08–0.71]) and apixaban (OR 0.18 [0.10–0.32]) were associated with a significantly lower odds of overdosing compared to rivaroxaban. Physicians accepted the pharmacists' advice in 179 cases (79.2%) consisting of 92 (51.4%) recommendations for underdosing, 82 (45.8%) for overdosing and 5 (2.8%) for contraindications. Conclusion: Inappropriate DOAC prescribing remains common, although there is a slight improvement compared to our study of 2016. Clinical services led by pharmacists help physicians to reduce the number of inadequate prescriptions for high‐risk medications such as DOACs. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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