Appropriateness of Dabigatran and Rivaroxaban Prescribing for Hospital Inpatients

Chowdhry, Unnum; Jacques, Amanda; Karovitch, Alan; Giguère, Pierre; Nguyen, My-Linh

doi:10.4212/cjhp.v69i3.1555

Cited by 8 publications

(14 citation statements)

References 20 publications

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“…Direct comparisons of the data obtained from the present study and those obtained from previous studies would be difficult, since all studies employed different criteria for inappropriate prescriptions. Nevertheless, the four studies [12–14, 18] that adopted criteria similar to those in the present study reported frequencies of potentially inappropriate dabigatran prescriptions (from 2.0 to 31.2%) comparable to that observed for inpatients in the present study (11%). In contrast, three other studies [15–17] reported substantially higher values (from 34.1 to 51.1%) than the present study.…”

Section: Discussionsupporting

confidence: 81%

“…To our knowledge, seven previous studies [12–18] reported the frequency of potentially inappropriate dabigatran prescriptions in real-world practice in different countries (Table 4). Direct comparisons of the data obtained from the present study and those obtained from previous studies would be difficult, since all studies employed different criteria for inappropriate prescriptions.…”

Section: Discussionmentioning

confidence: 99%

“…]CountryDesignNumber of patientsStudy patientsIM (%)Bleeding rate (%)CommentsArmbruster et al [12]USAR458I16.614.4-Simon et al [13]USAR395A216No serum creatinine levels were available within 1 week before and after the time of dabigatran initiation in 37% of patients.Kimmons et al [14]USAR160I9 a , 10 b 3.8 a Indication and b dose. Only 61% of patients were newly initiated on dabigatran during the study period.McDonald et al [15]USA, Canada and AustraliaR16,000A34.1–51.127.3–43.7PIM was judged solely by co-administration of medicines potentially increase bleeding risk c Larock et al [16]BelgiumP69I/A4914.7MAI was used for assessing PIMBasaran et al [17]TurkeyP148A47NAMAI was used for assessing PIMChowdhry et al [18]CanadaR109I31.2NA-The present studyJapanR228I/AI (11) vs. A (33)7.7Inappropriate prescription was judged according to the descriptions in prescribing information R retrospective chart review, P prospective study, I inpatients, A ambulant patients, MAI medication appropriate index, MAI is a tool designed to measure appropriateness of prescribing for people aged 65 years and older using 10 criteria comprising indication, choice, dosage, modalities and practicability of administration, drug-drug interaction and cost-effectiveness. [16, 17], IM inappropriate medication PIM potentially inappropriate medication, NA not available…”

Section: Discussionmentioning

confidence: 99%

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Impact of Pharmacists’ audit on improving the quality of prescription of dabigatran etexilate methanesulfonate: a retrospective study

Shimizu

Momose²,

Ogawa

et al. 2017

J Pharm Health Care Sci

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BackgroundAppropriate prescription of dabigatran etexilate methanesulfonate (JAN) is more complicated than assumed, because there are totally 10 items of contraindications and instructions for dosage reduction depending on patients’ characteristics. We aimed to study whether the routine audit of first-time prescriptions of dabigatran performed by pharmacists is effective in improving the quality of prescription.MethodsA retrospective re-audit was performed on all the prescriptions of dabigatran issued at Kitahara International Hospital, Tokyo between March 2011 and February 2014, by evaluating the prescriptions rigorously against the approved prescribing information of the drug. The original routine audit of the prescriptions for inpatients was performed by hospital pharmacists using electronic medical records (EMR), whereas the audit for ambulant patients receiving external prescriptions was performed by community pharmacists using information obtained mainly by questioning patients. The frequencies of inappropriate prescriptions detected by the re-audit in the two groups were compared.ResultsTwo hundred and twenty-eight patients (131 ambulant patients and 97 inpatients) were prescribed dabigatran for the first time during the study period. All patients met the approved indications. While 33% of the prescriptions for ambulant patients showed at least one violation of the approved usage, only 11% of the prescriptions for inpatients showed violations (p < 0.001). Two ambulant patients with creatinine clearance < 30 mL/min were dispensed dabigatran, whereas no such case was found among inpatients. A significantly greater proportion of ambulant patients aged ≥70 years showed violation of the instruction for dosage reduction compared to inpatients of the same age group (18 and 4%, respectively).ConclusionThe present study suggests that pharmacists may achieve better performance in auditing prescriptions of dabigatran when medical records are fully available than when information is available mainly by questioning patients. Further large-scale studies are required to clarify whether the audit of dabigatran prescriptions improves ultimate therapeutic outcomes or complications.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Pharmacists’ audit on improving the quality of prescription of dabigatran etexilate methanesulfonate: a retrospective study

Shimizu

Momose²,

Ogawa

et al. 2017

J Pharm Health Care Sci

View full text Add to dashboard Cite

show abstract

“…Similarly, data from the GLORIA‐AF registry showed that AF guideline adherence requires improvement, as nearly half of low‐risk patients are overtreated, and that patients at high risk of stroke were undertreated with oral anticoagulants . Studies from Larock et al McDonald et al and Chowdry et al also reported high values of potentially inappropriate dabigatran prescriptions (31.2–51.1%), which corroborates the problem of off‐label doses with dabigatran.…”

Section: Resultsmentioning

confidence: 86%

Impact of direct oral anticoagulant off‐label doses on clinical outcomes of atrial fibrillation patients: A systematic review

Santos

António

Rocha³

et al. 2020

Brit J Clinical Pharma

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Aims Worldwide observational studies are evidencing discordance between guidelines and real‐world practice regarding direct oral anticoagulant drug (DOAC) doses. This systematic review summarizes and evaluate DOACs use in real‐world practice. Methods This review was performed following the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines searching PubMed (MEDLINE) and Medscape databases. Results Data from 75 studies showed that most of the patients treated with DOACs for stroke prevention in atrial fibrillation received doses in accordance to the guidelines. However, a significant number of patients received off‐label doses (25–50% in most of the studies evaluated). DOAC overdosing was associated with increased all‐cause mortality and worse bleeding events while underdosing was associated with increased cardiovascular hospitalization and, particularly for apixaban, with a nearly 5‐fold increased risk of stroke. Conclusion Patients prescribed with off‐label DOAC doses did not receive the full benefit of anticoagulation and presented an increased risk of stroke, bleeding and/or adverse effects.

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“…Indeed published surveys report up to a third of hospital patients may receive an incorrect dose or are inappropriately prescribed a NOAC even when contraindicated. [11][12][13][14] The International Society on Thrombosis and Haemostasis (ISTH) 15 and European Heart Rhythm Association (EHRA) 16 provide practical guidance on the use of NOACs, emphasizing the need for appropriate patient selection, minimizing unnecessary drug-drug interactions, and monitoring for dosing errors, adherence, or adverse effects. Several models of care for the optimal follow-up and clinical monitoring of patients receiving therapy with NOACs have been proposed, 17 but there are currently no published studies evaluating the effectiveness of a nurse-led approach.…”

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confidence: 99%

Utility of a Nurse-Led Pathway for Patients with Acute Venous Thromboembolism Discharged on Rivaroxaban: A Prospective Cohort Study

Lim

Indran

Cummins

et al. 2018

Semin Thromb Hemost

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The highest risk of adverse events for patients with acute venous thromboembolism (VTE) is during the early anticoagulation period. However, no established model exists for early clinical monitoring of patients treated with non–vitamin K antagonist oral anticoagulants (NOACs). The authors' aim was to evaluate the utility of a nurse-led pathway to minimize adverse events in acute VTE patients starting on rivaroxaban. The rivaroxaban VTE treatment pathway is a prospective cohort study of consecutive patients with objectively confirmed VTE between July 2015 and May 2017. Primary outcome was the proportion of patients identified at major risk of adverse events (bleeding or recurrent VTE). Secondary outcomes were rates of interventions, major or clinically relevant nonmajor bleeding (CRNMB), recurrent VTE, and all-cause mortality at 90 days. Among 304 participants, 5% (n = 15) were identified to be at major and 9% (n = 28) at possible risk for adverse events. Appropriate interventions to prevent harm were required in 40 patients. Rates of major bleeding, CRNMB, recurrence, and all-cause mortality were 0.3% (95% confidence interval [CI]: 0.1–1.8), 7.2% (95% CI: 4.8–10.7), 1.0 (95% CI: 0.3–2.9), and 1.6% (95% CI: 0.7–3.8), respectively. In conclusion, following discharge of acute VTE patients, a nurse-led pathway identified one in seven (14%) patients at major or possible risk of adverse events. Preemptive interventions to reduce harm translated into the low rates of bleeding and recurrence. The authors' experience highlights the feasibility and importance of a structured clinical surveillance pathway for acute VTE patients initiating NOAC therapy.

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Appropriateness of Dabigatran and Rivaroxaban Prescribing for Hospital Inpatients

Cited by 8 publications

References 20 publications

Impact of Pharmacists’ audit on improving the quality of prescription of dabigatran etexilate methanesulfonate: a retrospective study

Impact of Pharmacists’ audit on improving the quality of prescription of dabigatran etexilate methanesulfonate: a retrospective study

Impact of direct oral anticoagulant off‐label doses on clinical outcomes of atrial fibrillation patients: A systematic review

Utility of a Nurse-Led Pathway for Patients with Acute Venous Thromboembolism Discharged on Rivaroxaban: A Prospective Cohort Study

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