Identification of risk factors for inappropriate and suboptimal initiation of direct oral anticoagulants

被引:42
作者
Howard, Molly [1 ]
Lipshutz, Andrew [2 ]
Roess, Breanne [3 ]
Hawes, Emily [4 ]
Deyo, Zachariah [5 ]
Burkhart, Jena Ivey [5 ]
Moll, Stephan [6 ]
Shilliday, Betsy Bryant [7 ]
机构
[1] Auburn Univ, Harrison Sch Pharm, Cent Alabama Vet Hlth Care Syst, 8105 Vet Way, Montgomery, AL 36117 USA
[2] Mt Carmel West Hosp, 793 West State St, Columbus, OH 43222 USA
[3] Univ Chicago, Med Ctr, 5841 S Maryland Ave, Chicago, IL 60637 USA
[4] Univ North Carolina UNC Hlth Care, UNC Sch Med, UNC Eshelman Sch Pharm, Dept Family Med, 590 Manning Dr,Campus Box 7600, Chapel Hill, NC 27599 USA
[5] Univ North Carolina UNC Hlth Care, UNC Eshelman Sch Pharm, 101 Manning Dr,Campus Box 7600, Chapel Hill, NC 27514 USA
[6] Univ North Carolina UNC, Div Hematol Oncol, Dept Med, Sch Med, Campus Box 7035, Chapel Hill, NC 27599 USA
[7] Univ North Carolina UNC, Dept Med, Div Gen Med, Sch Med,UNC Eshelman Sch Pharm, 5034 Old Clin Bldg,Campus Box 7110, Chapel Hill, NC 27599 USA
关键词
Direct oral anticoagulants; Target specific oral anticoagulants; New oral anticoagulants; Initiation; Prescribing; Risk factors; DECISION-SUPPORT-SYSTEMS; DABIGATRAN; PREVENTION; WARFARIN;
D O I
10.1007/s11239-016-1435-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Direct Oral Anticoagulants (DOACs) require specific dosing and monitoring to ensure safe and appropriate use. The purpose of this evaluation was to identify patient- and process-related factors that correlate with increased risk of inappropriate prescribing of DOACs. A retrospective chart review was conducted in three outpatient clinics within an academic medical center to identify patients started on DOAC therapy and evaluate the appropriateness of DOAC initiation. Data collected included patient demographics, DOAC medication initiated, dose, indication, baseline laboratory values, concomitant medications, type and specialty of prescriber, and initiation setting. Appropriateness of initial dose was assessed and data were analyzed in order to identify factors correlating with inappropriate use. One-hundred sixty-seven patients initiated on a DOAC were identified. Most patients were prescribed anticoagulation for atrial fibrillation (74.9 %) and most commonly prescribed rivaroxaban (62.9 %). An inappropriate dose was prescribed in 24 (14.4 %) patients. Female patients and patients over 75 years were more likely to be prescribed an inappropriate initial dose. Baseline evaluation of blood counts and organ function were often not performed: hemoglobin values had not been drawn within the month prior to initiation in 28.7 % of patients, serum creatinine in 22.8 %, alanine transaminase in 52.1 %, and total bilirubin in 64.1 %. Lack of baseline labs was more pronounced in patients initiated on a DOAC in the outpatient setting. Dosing and baseline lab collection for DOAC initiation were suboptimal in all settings analyzed. Targeted interventions are needed to ensure the safe and appropriate use of DOAC therapy.
引用
收藏
页码:149 / 156
页数:8
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