Evaluation of the appropriateness of dosing, indication and safety of rivaroxaban in a community hospital

Tellor, Katie B.; Patel, Salma; Armbruster, Anastasia L.; Daly, Michael W.

doi:10.1111/jcpt.12288

Cited by 30 publications

(30 citation statements)

References 9 publications

(19 reference statements)

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“…However, other studies have indicated that pharmacist interventions in the follow-up of patients with VKAs generate significant cost avoidance 12. Moreover, a recent study showed similar figures on the inappropriateness of the prescription 13. Both inappropriateness ratios were above 28%, which is the net cost benefit breakpoint in our sensitivity analysis.…”

Section: Discussionsupporting

confidence: 74%

Partial economic evaluation of clinical pharmacy interventions on the prescription of direct oral anticoagulants in a teaching hospital

et al. 2017

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BackgroundPotential inappropriate use of direct oral anticoagulants (DOACs) increases the risk of thromboembolic and haemorrhagic events.PurposeTo determine the net cost benefit of clinical pharmacy interventions on the prescription of DOACs.MethodWe constructed a decision tree model using a public payer perspective. The appropriateness of the prescription was assessed using the Medication Appropriateness Index. The theoretical risks were collected from the literature and the individual potential risks were calculated using the Nesbit risk assignment conducted by two independent clinical pharmacists. Different costs were included based on diagnosis-related group coding and data in the literature. A univariate sensitivity analysis was performed.ResultsThirty-six of 75 patients had an inappropriate prescription of DOACs. The saved difference between avoided costs (7954€) and annualised medication costs and pharmacist cost (4323€) was 3631€ for 75 patients.ConclusionsIn addition to the enhancement of the quality of the prescription, our results indicate that pharmacist interventions provide a positive net cost benefit.

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Section: Discussionsupporting

confidence: 74%

Partial economic evaluation of clinical pharmacy interventions on the prescription of direct oral anticoagulants in a teaching hospital

et al. 2017

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“…(C) Real‐world studies results concerning dose adjustments of apixaban. (D) Results from direct oral anticoagulants overall adjustments regarding dose appropriateness…”

Section: Resultsmentioning

confidence: 99%

“…Canadian study, 44 where a total of 47 patients were included, among (D) Results from direct oral anticoagulants overall adjustments regarding dose appropriateness 5,9,11,25,27,28,32,34,37,39,40,42,44,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] whom 25 (53%) were receiving apixaban inconsistent with the ARIS-TOTLE trial and the product monograph.…”

Section: Study and Also By A Smallmentioning

confidence: 99%

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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“…However, this has been reported to be as high as 10 to 20% in other studies. 13,28,29 We demonstrated that these patients could be identified quickly through our nurse-led pathway and that timely corrective action and education were easily instituted by telephone.…”

Section: Risk Factors For Bleeding or Recurrencementioning

confidence: 91%

“…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.…”

mentioning

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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Evaluation of the appropriateness of dosing, indication and safety of rivaroxaban in a community hospital

Abstract: Though offering potential advantages over warfarin, the use of rivaroxaban should be monitored to increase appropriateness of therapy and improve patient safety. Therapeutic interchanges, pharmacist-directed interventions and other initiatives can be implemented to ensure appropriate use.

Cited by 30 publications

References 9 publications

Partial economic evaluation of clinical pharmacy interventions on the prescription of direct oral anticoagulants in a teaching hospital

Partial economic evaluation of clinical pharmacy interventions on the prescription of direct oral anticoagulants in a teaching hospital

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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