Authors (including presenting author) :
Lo KW(1), Chan YH(1), Fan SY(1)
Affiliation :
(1) Pharmacy, Pamela Youde Nethersole Eastern Hospital, HKEC
Introduction :
Direct Oral Anticoagulants (DOAC) are important alternatives to warfarin for the management of thromboembolism. These drugs require dosage adjustment according to the patient’s clinical situation, and, sometimes, a transition to or from other anticoagulants may be required. Therefore, prescribing DOAC, a high-risk drug, can be challenging and prone to serious medication errors.
Objectives :
(1) To evaluate the percentage of the appropriate use of DOAC and transition of DOAC to or from other anticoagulants; (2) To identify common reasons of inappropriate use of DOAC; and (3) To determine the incidence of adverse drug reactions related to DOAC
Methodology :
This was a retrospective, observational study conducted in Pamela Youde Nethersole Eastern Hospital. Patients aged ≥18 years old and received DOAC during the hospitalizations or at discharges between 1 January 2018 and 31 March 2018 were included in the evaluation. Their medical records and prescriptions were reviewed to determine the appropriateness of the use of DOAC, based on the drug information provided in local product inserts. Patients with missing information to justify the appropriateness of the DOAC were excluded.
Result & Outcome :
362 patients were recruited. 244 (67%) patients received DOAC on admission. This number increased to 357 (99%) at discharge.
276 (76%) patients received DOAC appropriately based on the indication, contraindication, dosage, and duration. 66 (18%) patients receive inappropriately dosed DOAC, which accounted for the most common reason for inappropriateness. 39 (59%) of the 66 patients’ DOAC were unnecessarily adjusted to a suboptimal dosage.
18 patients required a transition of DOAC and had sufficient clinical information to determine its appropriateness in transition. 12 (67%) patients’ anticoagulant prescriptions were appropriately transitioned. All 6 (33%) inappropriately transitioned cases were inappropriate timing of the transitioned anticoagulants, leading to either overlapping or delayed administration.
8 patients reported to have adverse effects related to DOAC and none were related to inappropriateness of DOAC prescriptions.
