Direct oral anticoagulants: a review of common medication errors

Barr, Drakeria; Epps, Quovadis J

doi:10.1007/s11239-018-1752-9

Cited by 34 publications

(21 citation statements)

References 38 publications

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“…It should be noted that several commonly prescribed drugs can potentiate or inhibit DOAC activity and include diltiazem, ketoconazole and carbamazepine. Such interactions have recently been reviewed in detail elsewhere 17. To date, two RCTs have been published comparing warfarin treatment with rivaroxaban for secondary thrombotic prophylaxis in APS.…”

mentioning

confidence: 99%

An update on the management of antiphospholipid syndrome

Rodziewicz

D’Cruz

2020

Therapeutic Advances in Musculoskeletal

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Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by recurrent venous or arterial thrombosis with or without pregnancy morbidity in the presence of persistent antiphospholipid (aPL) autoantibodies. Anticoagulation has, until now, formed the cornerstone of treatment but a significant proportion of patients continue to experience thrombosis and pregnancy morbidity despite this treatment. Thrombosis is the most common cause of mortality and accounts for two fifths of deaths. Direct oral anticoagulant drugs represent an attractive alternative to conventional vitamin K antagonist drugs but emerging evidence suggests these may not be suitable for high-risk patients with thrombotic APS. Laboratory studies and case reports of the successful use of different classes of drugs in APS is increasing our understanding of the other pathophysiological mechanisms which may contribute to the high morbidity of APS. This review summarizes current accepted anticoagulant treatment for APS and examines other potential drugs such as immunomodulating agents, statins and novel agents such as sirolimus and defibrotide.

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confidence: 99%

An update on the management of antiphospholipid syndrome

Rodziewicz

D’Cruz

2020

Therapeutic Advances in Musculoskeletal

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“…anticoagulant-related medication errors occurred mainly in the prescribing phase and in about 56% of errors lowmolecular-weight heparins (LMWH) were involved [2,4]. Consistently, a similar descriptive study on the Danish patient safety database reported that the adverse medication incidents occurred mainly in the prescribing phase, and in about 80% of incidents the errors occurred at the time of sector changes (at the admission, at the discharge or ward changes) [5].…”

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confidence: 72%

“…From this population, all patients admitted to our in-patient wards, from 21.08.2017-20.08.2018, who concomitantly received at least two ACs were included in the study. Subsequently, the following patients have been excluded: [1] patients who received the anticoagulants separately, no overlapping prescription [2] patients treated with the combination of heparin/ heparin analogs and vitamin-K antagonists (VKA) [3] patients receiving heparin/ heparin analogs based on a weekly schedule such as patients with hemodialysis [4] patients receiving low-dose alteplase (= < 4 mg) as a catheter locking solution [5] patients treated with the combination of VKA and direct oral anticoagulants (DOACs) during bridging from DOACs to VKA [6] patients who explicitly refused participation in research.…”

Section: Patient Populationmentioning

confidence: 99%

Therapeutic duplication of anticoagulants: a retrospective study of frequency and consequences in a tertiary referral hospital

et al. 2020

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Background: Anticoagulants are commonly prescribed in medical practices and could be of significant harm in the case of medication errors. We conducted a retrospective observational study to determine the frequency and consequences of the therapeutic duplication of anticoagulants (TDA). As a secondary objective, we aimed to determine the characteristics of the population in which TDA occurs. Methods: We conducted a retrospective observational study among admitted patients who concomitantly received at least two anticoagulants from August 2017 to August 2018. Results: A total of 107 patients with TDA are included in the research. The patients with TDA have a mean age of 73. The TDA population has a high rate of associated comorbidities with 69% of patients having arterial hypertonia, 40% with chronic kidney disease, 26% with a history of malignancy, and 20.5% with a history of stroke. More than 65% of patients were under anticoagulation before admission, mostly due to atrial fibrillation. The TDA occurred in more than 95% of cases in the first week or the last week of hospitalization. Patients had a high risk of bleeding prior to the TDA-event with about 62.5% of TDA patients having a HAS-BLED score at least 3. A total of 8 patients showed a significant Hemoglobin (Hb)-drop of at least 10 g/L within 24 h after TDA-event. Two patients had a new or worsened hematuria following TDA-event. Conclusion: TDA occurred in 0.8% of patients who were under anticoagulation and in 6.7% of patients who received direct oral anticoagulants (DOACs). TDA led in about 7.4% of cases to hemoglobin-relevant bleeding. The old patients with significant comorbidities and a high HAS-BLED score were mainly affected. The female gender and presence of anemia independently predicted the occurrence of bleeding following TDA.

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“…An annual anticoagulation review is classed as an essential element for providing an excellent service. Other guidelines recommend the use of a multidisciplinary team working to standardised policies to improve anticoagulant prescribing and the development of a shared care approach across the interface between primary and secondary care (Kvamme et al, 2001;Barr and Epps, 2019). Currently there is no standardised review for patients prescribed a DOAC or warfarin (regardless of indication) in our local area or nationally.…”

Section: Addressing the Problem Identified By The Auditmentioning

confidence: 99%

Implementation of a standardised annual anticoagulation specialist review in primary care

Hutchinson-Jones

Didcott

Jones

et al. 2020

Prim Health Care Res Dev

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An increasing number of patients are being prescribed direct oral anticoagulants (DOACs), while the patients who remain on warfarin are becoming more complex. There is currently a lack of a standardised anticoagulation review for patients in primary care, resulting in potentially preventable harm events. Our aim was to implement a new service, where a standardised review is carried out by a specialist multidisciplinary secondary care anticoagulation team. Overall, the implementation of a standardised review resulted in better optimisation of anticoagulation management for patients taking either a DOAC or a warfarin. Of the 172 eligible patients prescribed warfarin, 47 (27%) chose to switch a DOAC. The average time in therapeutic range for patients on warfarin before and after the pilot increased from 73.5% to 75%. Of 482 patients taking a DOAC, 35 (7%) were found to be on incorrect dose. In 32 (91%) of 35 patients, the dose was amended after notifying the patient’s general practitioner. We also found a significant number of patients inappropriately prescribed concomitant medication such as antiplatelet or non-steroidal anti-inflammatory drugs, potentially putting the patients at an elevated risk of bleeding. While further research is needed; we believe the results of this pilot can be used to help build a case to influence the commissioning of anticoagulation services. Secondary care anticoagulation teams, like our own, may be well-placed to provide or support such services, by working across the primary care and secondary care interface to support our primary care colleagues.

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Direct oral anticoagulants: a review of common medication errors

Cited by 34 publications

References 38 publications

An update on the management of antiphospholipid syndrome

An update on the management of antiphospholipid syndrome

Therapeutic duplication of anticoagulants: a retrospective study of frequency and consequences in a tertiary referral hospital

Implementation of a standardised annual anticoagulation specialist review in primary care

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