Preventability of serious thromboembolic and bleeding events related to the use of oral anticoagulants: a prospective study

Abstract

More than half of serious ADRs were potentially preventable for both DOACs and VKAs. Interventions focusing on prescribing, patient education and continuity of care should help improve the use of DOACs in practice.

Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis

“…Out of the 32 studies, 12 (40.7%) were conducted in the USA [ 15 , 19 , 20 , 24 , 33 , 35 , 37 – 40 , 42 , 44 ]; three each in the UK (11.1%) [ 22 , 34 , 45 ] and France [ 18 , 30 , 46 ]; two each in Belgium [ 31 , 36 ], Greece [ 27 , 28 ], Australia [ 23 , 41 ], Ireland [ 29 , 32 ]; and one each in the Netherlands [ 21 ], Spain [ 43 ], Turkey [ 17 ], Israel [ 16 ], Denmark [ 25 ], and United Arab of Emirates [ 26 ]. Studies were conducted in university-affiliated or academic/teaching hospitals [ 15 , 16 , 18 , 23 , 25 , 28 – 31 , 34 , 36 , 37 , 39 , 41 , 43 , 45 , 46 ], tertiary care non-teaching hospitals [ 24 , 26 , 33 , 35 , 38 , 42 ], primary healthcare centres [ 22 , 43 ], nursing home [ 19 ], private general hospital [ 27 ], pharmacist managed anticoagulation clinic [ 20 ], central medication registration [ 21 ], Poison control system [ 40 ], single center [ 32 ], and patient safety reporting system [ 44 ].…”

“…About three quarter of the studies ( n = 24) used retrospective routinely collected data [ 15 , 16 , 19 , 21 – 26 , 29 , 31 – 35 , 37 – 40 , 42 – 46 ], six used prospective observational design [ 17 , 18 , 27 , 30 , 34 , 36 ], while two studies used mixed study design which were combined with a retrospective chart review, prospective observational data, and clinical trial design [ 20 , 28 ] (Table 1 ).…”

“… Mistake: wrong dose NR NR Valentine et al [ 44 ] USA Retrospective reviewed database Pennsylvania Patient Safety Reporting System database Pennsylvania Patient Safety Reporting System database 1,811 1,546 Duplicate therapy; errors reported to a reporting system Rivaroxaban, edoxaban, apixaban, dabigatran AF, DVT, and PE Of the 1,811 reports, 14.6% (n = 265) were considered ADEs and 85.4% (n = 1,546) were medication errors without harm. NR NR NR Sennesael et al [ 36 ] Belgium Prospective observational study in the emergency departments Teaching hospitals Patients admitted with a thrombotic or bleeding event while under DOAC 46 38 Prescribing issues and inadequate monitoring; prospective medication review Rivaroxaban, apixaban, dabigatran NVAF, VTE For the 46 patients taking DOAC, 38 adverse events were evaluated as serious ADRs. Among these, 20 ADRs (53%) were considered to be (potentially) preventable.…”

A 79‐year‐old woman with atrial fibrillation and new onset of heart failure

“…7 Most probably, the bleeding events in our patient resulted from overanticoagulation by prescribing standard anticoagulant doses for this small and underweight lady. 8 In addition, there may have been insufficient laboratory Atrial fibrillation and new onset of heart failure monitoring during therapy with a vitamin K antagonist. Because of multiple bleeding events during anticoagulation and a CHA 2 DS 2 -VASc score of 5, the patient had undergone interventional LAA closure.…”

Safe and Effective Digital Anticoagulation: A Continuous Iterative Improvement Approach

“…3,4 They rank in the top five drug types associated with patient harm, including fatal medication incidents. 5 More than 50% of anticoagulation-related adverse events are potentially preventable, 6 leading the Joint Commission to include anticoagulants as part of the National Patient Safety Goal program. 7 Anticoagulants are the leading cause of medication related hospital admissions 8 and 8.3% of medication errors in hospitals and primary care involve anticoagulants.…”