Assessment of Novel Oral Anticoagulant use within a Community Teaching Hospital

Journal Article
PharmD, Sultan Mohammed Alghadeer, . 2016
نوع عمل المنشور: 
زمالة صيدلية
المجلة \ الصحيفة: 
Saudi Pharmaceutical Journal
مستخلص المنشور: 

The purpose of this study was to evaluate the appropriate use of the novel oral anticoagulants (NOACs) within a community teaching hospital. A retrospective chart review of patients prescribed dabigatran, rivaroxaban, or apixaban at our institution from October 2012 thru November 2014 was conducted. The primary objectives were to determine the percentage of patients appropriately prescribed NOACs and specifically the percentage of patients who received the correct dose of each agent based on the specific indication, renal function, age and/or body weight and concomitant medications. Secondary objectives were to determine the number of patients who were inappropriately transitioned from warfarin or parenteral anticoagulants to a NOAC or vice versa, the number of incidents when a NOAC was held or discontinued inappropriately before a procedure and the number of bleeding or thrombotic events. Of the 110 patients receiving therapy with an NOAC, appropriate prescribing was observed in 79.6%. Dabigtran, rivaroxaban, and apixaban were appropriately prescribed in 73.8%, 88.3%, and 85.8% of patients respectively. Ten out of 38 patients were inappropriately transitioned from/to other anticoagulants. Three out of six patients underwent a procedure without holding NOACs as recommended prior to surgery. Of all patients receiving NOACs, a total of 3 bleeding incidents were observed, one with each NOAC.  The novel oral anticoagulants were appropriately prescribed for the majority of patients within our institution. However, future efforts should focus on areas such as dose adjustment for renal impairment, appropriate procedures for transitioning between NOACs and parenteral anticoagulants, and adequate withholding times for NOACs prior to surgery in order to optimize the management of NOACs usage within our institution.