Effect of a novel pharmacist-led reporting system on appropriate use of direct-acting oral anticoagulants (DOACs) in a patient-centered medical home

Darnell, Toni; Hughes, Jonathan; Turner, Ben; Ragheb, Melissa; Wunderlich, Allyson

doi:10.1007/s11239-020-02223-3

Cited by 3 publications

(4 citation statements)

References 9 publications

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“…9,10 The introduction of several molecules, along with expanding indications and rapidly evolving literature, has contributed to the complexity of DOAC prescribing. 11,12 Factors such as age, weight, kidney function, and medication interactions must be considered when prescribing DOACs. 13 Furthermore, different indications can be associated with different dosing regimens.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Over the past decade, there has been a shift toward favoring direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs) 9,10 . The introduction of several molecules, along with expanding indications and rapidly evolving literature, has contributed to the complexity of DOAC prescribing 11,12 . Factors such as age, weight, kidney function, and medication interactions must be considered when prescribing DOACs 13 .…”

Section: Introductionmentioning

confidence: 99%

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Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription

Koolian

Wiseman

Mantzanis

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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Background Anticoagulants are a leading cause of morbidity among hospitalized patients, with prescription errors commonly reported. Literature surrounding anticoagulation stewardship is scarce despite its documented effectiveness in the antimicrobial realm. Objective To determine the proportion of accepted recommendations on inappropriate anticoagulant prescriptions suggested by a multidisciplinary anticoagulation stewardship program (ASP). Methods We conducted a descriptive cohort study of hospitalized patients using therapeutic anticoagulation at a large Canadian tertiary care center between September 1, 2019, and February 28, 2020. A multidisciplinary ASP, composed of physicians and pharmacists, was implemented on June 1, 2019. Patient‐, anticoagulant‐, and admission‐related characteristics were collected. The primary outcome was the proportion of accepted ASP team recommendations by the prescribing team. Results A total of 381 patients were enrolled during the study period, resulting in 553 anticoagulant reviews (1.56 reviews/patient) by the ASP. The most common indications for anticoagulation were atrial fibrillation (n = 276, 72%) and venous thromboembolism (n = 84, 22%). Direct oral anticoagulants were most frequently prescribed (n = 253, 67%), followed by vitamin K antagonists (n = 88, 23%). Among the reviewed prescriptions, 355 of 553 (64%) generated a recommendation; 299 of 355 (84%) recommendations were accepted by the treating team. Dose adjustments were the leading category of recommendations (31%), followed by alerts regarding drug interactions (19%). Conclusion Inpatient anticoagulant prescriptions were optimized following recommendations by the ASP team. The most frequent types of prescription changes concerned dose adjustments and drug interactions. Further research is required to assess the effect of an ASP on clinical outcomes.

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Section: Backg Rou N Dmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription

Koolian

Wiseman

Mantzanis

et al. 2022

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

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“…To date relatively limited data is available regarding the benefits of dedicated DOAC monitoring services. One study utilized a computer algorithm to identify potential dosing problems for new DOAC prescriptions and found 15 potential problems out of 107 prescriptions, 14 of which were ultimately changed 12 . Another center utilized daily electronic prescribing reports to identify new and refill prescription orders for a DOAC that a pharmacist then reviewed and attempted to contact the patient; 125 out of 317 patients receiving a new prescription were contacted as well as 59 out of 595 patients receiving a refill.…”

Section: Introductionmentioning

confidence: 99%

“…One study utilized a computer algorithm to identify potential dosing problems for new DOAC prescriptions and found 15 potential problems out of 107 prescriptions, 14 of which were ultimately changed. 12 Another center utilized daily electronic prescribing reports to identify new and refill prescription orders for a DOAC that a pharmacist then reviewed and attempted to contact the patient; 125 out of 317 patients receiving a new prescription were contacted as well as 59 out of 595 patients receiving a refill. After pharmacist review and patient contact a total of 79 (28%) and 86 (15.5%) of calls led to an intervention for the new and refill prescription orders, respectively.…”

mentioning

confidence: 99%

Three‐year clinical interventions from an outpatient multidisciplinary direct oral anticoagulant monitoring service

Dietrich

Davis

Talana³

et al. 2022

J Am Coll Clin Pharm

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Introduction: Direct oral anticoagulants (DOAC) are increasingly utilized for the prevention of thrombotic events. Unlike warfarin they do not require drug-level monitoring making dedicated DOAC monitoring uncommon. The purpose of this study is to describe the interventions made by a DOAC monitoring service over 3 years. Materials and Methods: This was a single-center prospective observational study of patients seen at an outpatient clinic between February 14, 2017 and February 13, 2020. Following referral patients met a pharmacist for a DOAC-specific visit. Patient demographics and clinical interventions were collected for all patients. Continuous quality improvement status was received from the local Institutional Review Board. Results: A total of 153 patients completing 336 visits were included. The median age was 75 years (interquartile range [IQR] 69-81) and 41.2% were male. Apixaban was the most common DOAC (82.4% of visits) and atrial fibrillation (AF) was the most common indication (69.7% of visits). A total of 299 interventions were made over 336 visits with an average of 0.9 interventions per visit; the first visit had an average of 1.1 interventions per visit made. Need for updated laboratory monitoring (101 visits, 30.1% of visits) was the most common intervention. There were 94 interventions related to nonadherence and 24 interventions for incorrect dosing due to renal function, drug-drug interaction, or indication. Conclusions: A DOAC monitoring service frequently made interventions. Routine DOAC monitoring should be considered for all patients. It remains unclear if routine DOAC monitoring reduces the rate of clinical outcomes.

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Peripheral Arterial Disease and the Pharmacist’s Role in Management

Stacy

2023

Journal of Clinical Pharmacy and Therapeutics

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Purpose. Atherosclerosis of arteries in the legs leads to peripheral arterial disease (PAD), increasing the risk of future cardiovascular events. Worldwide prevalence estimates indicate >200 million people have PAD, but this is likely underestimated given the variability in symptoms and lack of awareness by patients and clinicians. Antiplatelet therapy is recommended to reduce cardiovascular risk, but anticoagulation therapy may also be beneficial. This narrative review examined scientific literature for the burden and medical management of PAD, including use of anticoagulants in this population, and provides perspectives on the role of pharmacists to improve outcomes of PAD. Summary. A variety of antiplatelet therapies has been studied in patients with PAD, and treatment is recommended for those with symptomatic disease. The use of dual antiplatelet therapy is limited to patients with symptomatic PAD after revascularization. Anticoagulation with warfarin in combination with antiplatelet therapy did not improve efficacy over antiplatelet therapy alone and increased bleeding. In contrast, the direct factor Xa inhibitor rivaroxaban, when used in combination with low-dose aspirin, has been shown to significantly reduce the risk of cardiovascular death, myocardial infarction (MI), or stroke by 28% in patients with PAD compared with aspirin alone. Similarly, in patients with PAD who have undergone revascularization, rivaroxaban plus aspirin reduced the risk of acute limb ischemia, major amputation, MI, stroke, or cardiovascular death by 15% versus aspirin alone. Major bleeding was significantly increased with rivaroxaban plus aspirin, but with no differences in fatal bleeding, nonfatal intracranial hemorrhage, or symptomatic bleeding into a critical organ between groups. Pharmacist-led interventions for patients with PAD include identifying at-risk patients through medication reviews and clinical assessments, education and monitoring use of prescription and over-the-counter medications, and appropriate counseling on lifestyle modifications. Conclusion. Rivaroxaban plus aspirin reduces the risk of major cardiovascular events, including major adverse limb events and amputation, in patients with PAD. Pharmacists can play an integral role in identifying, screening, and managing patients with PAD to achieve favorable outcomes.

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Effect of a novel pharmacist-led reporting system on appropriate use of direct-acting oral anticoagulants (DOACs) in a patient-centered medical home

Cited by 3 publications

References 9 publications

Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription

Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription

Three‐year clinical interventions from an outpatient multidisciplinary direct oral anticoagulant monitoring service

Peripheral Arterial Disease and the Pharmacist’s Role in Management

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