DIRECT ORAL ANTICOAGULANTS PRESCRIBING PRACTICES IN THE TREATMENT OF VTE AT A QUATERNARY CARE CENTER: A RETROSPECTIVE REVIEW

Obesity plays an essential role in the safety of pharmacologic drugs. There is paucity of data for direct oral anticoagulants (DOACs) in the obese, despite these agents becoming more widely used. The primary and secondary objectives of this study were to assess the safety and efficacy of DOACs in the overweight and obese populations when used for primary prophylaxis in the setting of non-valvular atrial fibrillation (NVAF) and for treatment of venous thromboembolisms (VTE). We conducted a retrospective cohort study in a large tertiary care center and obtained data through review of electronic health records. Among patients with NVAF and VTE on apixaban, there were no differences in rates of major bleeding (MB) and clinically relevant nonmajor bleeding (CRNMB) in the overweight and obese populations when compared to normal weight and underweight individuals. The multivariate adjusted analysis for rivaroxaban found that the odds of CRNMB for patients with BMI <25 was 5.37 (95% CI 1.50–19.32) times higher than that of BMI ≥25. Moreover, patients on medications that had known interactions with DOACs had 6.40 times higher odds of CRNMB than patients without such interactions (95% CI 1.49–27.57), which was not accounted for by the effects of aspirin and plavix alone. Efficacy was similar between all weight groups, for both apixaban and rivaroxaban. These results support previous analyses preformed in the large phase III trials and confirm that apixaban and rivaroxaban are safe in the overweight and obese.

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A Multisite Retrospective Review of Direct Oral Anticoagulants Compared to Warfarin in Adult Fontan Patients

Cardiovascular Drugs and Therapy ◽

10.1007/s10557-021-07298-5 ◽

2022 ◽

Author(s):

Amir Kazerouninia ◽

Justin Georgekutty ◽

Payton Kendsersky ◽

Ryan D. Byrne ◽

Brendan Seto ◽

...

Keyword(s):

Retrospective Review ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Fontan Patients

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Evaluation of the Appropriateness of Direct Oral Anticoagulant Selection and Monitoring in the Outpatient Setting

Journal of Pharmacy Technology ◽

10.1177/8755122517698976 ◽

2017 ◽

Vol 33 (3) ◽

pp. 108-113 ◽

Cited By ~ 2

Author(s):

Kristin N. Rieser ◽

Eric I. Rosenberg ◽

Katherine Vogel Anderson

Keyword(s):

Internal Medicine ◽

Data Collection ◽

Laboratory Tests ◽

Complete Blood Count ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Published Data ◽

Laboratory Monitoring ◽

Monitoring Methods ◽

Prescribing Practices

Background: Direct oral anticoagulants (DOACs) share many indications with warfarin but require less frequent follow-up and monitoring. There is limited data available on the prescribing of DOACs and appropriate laboratory monitoring in a real-world clinical setting. Objective: To determine if patients receiving care at 2 University of Florida (UF) Health Internal Medicine clinics are prescribed DOACs according to Food and Drug Administration (FDA)–approved labeling. Secondary objectives were to determine the percentage of patients receiving appropriate baseline laboratory tests prior to DOAC initiation and the frequency of laboratory monitoring. Methods: This retrospective chart review evaluated patients enrolled at 2 UF Health Internal Medicine practices within the UF Health system who were prescribed a DOAC between April 2014 and April 2015. Adherence to FDA-approved dosing recommendations and baseline laboratory tests were compared to previously published data. This study was approved by the UF Institutional Review Board. Results: A total of 194 patients met inclusion criteria. Ninety-six patients (49.5%) were on a DOAC prior to data collection; 98 patients (50.5%) started a DOAC during data collection. Of the 194 patients, 155 (79.9%) were prescribed DOACs per FDA-approved labeling ( P = .0005); 79 (40.8%) obtained a complete blood count, serum creatinine, and liver function tests prior to DOAC initiation. Conclusions: Prescribing practices were significantly better than published data; however, 1 in 5 patients were not prescribed a DOAC according to FDA-approved labeling. Less than half of the patients started on a DOAC obtained the recommended labs prior to medication initiation.

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Suboptimal Use of Oral Anticoagulants in Atrial Fibrillation: Has the Introduction of Direct Oral Anticoagulants Improved Prescribing Practices?

American Journal of Cardiovascular Drugs ◽

10.1007/s40256-016-0161-8 ◽

2016 ◽

Vol 16 (3) ◽

pp. 183-200 ◽

Cited By ~ 45

Author(s):

Endalkachew A. Alamneh ◽

Leanne Chalmers ◽

Luke R. Bereznicki

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Prescribing Practices

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Influence of stroke and bleeding risk on prescribing of oral anticoagulants in older inpatients; has the availability of direct oral anticoagulants changed prescribing?

Therapeutic Advances in Drug Safety ◽

10.1177/2042098617747835 ◽

2017 ◽

Vol 9 (2) ◽

pp. 113-121 ◽

Cited By ~ 4

Author(s):

Nicholas Farinola ◽

Gillian E. Caughey ◽

J. Simon Bell ◽

Sally Johns ◽

Milka Hauta-aho ◽

...

Keyword(s):

Oral Anticoagulant ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Bleeding Event ◽

Bleeding Risk ◽

Prescribing Practices ◽

Treatment Groups ◽

Prescribing Practice ◽

Older Inpatients ◽

Hospital Inpatients

Background Little is known about changes in prescribing practices in Australia since the introduction of the direct oral anticoagulants (DOACs). Our objective was to examine if the availability of DOACs has coincided with a change in prescribing of oral anticoagulants in older hospital inpatients with regard to risk factors for stroke and bleeding. Methods A prospective observational study was conducted between October 2012 and August 2015 of inpatients aged over 60 years initiated on an oral anticoagulant in a large metropolitan, tertiary referral, public teaching hospital in Australia. Treatment groups were patients who commenced an oral anticoagulant prior to inclusion of DOACs on the formulary and those who commenced after the introduction of DOACs. Subgroup analyses were conducted in patients with atrial fibrillation (AF). Differences in clinical characteristics and risk for stroke and bleeding were calculated using the CHADS2 and HAS-BLED scores, respectively, were examined. Results A total of 289 patients were included. Inpatients prescribed an oral anticoagulant after the introduction of DOACs were significantly older, a greater proportion were female and more likely to have had a prior stroke. This was associated with a statistically higher CHADS2 score in the post-DOAC group. Similar findings were observed when limiting the sample to patients with AF. Patients with AF who were at greatest likelihood of having a bleeding event were less likely to be treated with a DOAC. Conclusion Since the introduction of the DOACs, patients who may have previously received no therapy or suboptimal treatment were now more likely to be receiving anticoagulation, suggesting an appropriate change in prescribing practice.

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Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-019-01857-2 ◽

2019 ◽

Vol 48 (3) ◽

pp. 359-365 ◽

Cited By ~ 9

Author(s):

Jared Netley ◽

Kris Howard ◽

William Wilson

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Retrospective Review ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants

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Retrospective Review of Prescribing Patterns in Cancer-Associated Thrombosis: A Single Center Experience in Edmonton, Alberta, Canada

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620975489 ◽

2021 ◽

Vol 27 ◽

pp. 107602962097548

Author(s):

Hannah Kaliel ◽

Meghan Mior ◽

Steven Quan ◽

Sunita Ghosh ◽

Cynthia Wu ◽

...

Keyword(s):

Retrospective Review ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Chronic Phase ◽

Standard Of Care ◽

Prescribing Patterns ◽

Real World Data ◽

Cancer Trial ◽

Single Center Experience ◽

Cancer Associated Thrombosis

Low molecular weight heparin (LMWH) is the standard of care for treating cancer-associated thrombosis (CAT), although new evidence for direct oral anticoagulants (DOACs) supports use in specific cancer populations. In this retrospective review at a specialty CAT clinic from 2016 to 2019, we report the use of anticoagulants (LMWH, DOACs, warfarin, anticoagulant class change) in the acute and chronic phases of CAT and compare use before/after publication of the Hokusai-VTE Cancer trial. Death, venous thromboembolism (VTE) recurrence and bleeding was also reported. Of the 221 included, median age was 69 years, with 57.5% having metastatic disease. In the acute phase, 80.1% were prescribed LMWH, 4.1% DOAC, and 14.5% had an anticoagulant class change (LMWH to DOAC; 78.1%). In the chronic phase, 35.8% were prescribed LMWH, 11.3% DOAC, and 42.9% had an anticoagulant class change (LMWH to DOAC; 90.1%). Use of DOACs in the acute and chronic phase prior to the Hokusai-VTE trial was 1.0% and 2.0%, respectively, and following publication was 6.8% and 19.6%. Death occurred for 22.6% patients, recurrent VTE in 7.2%, and bleeding in 5.0%. DOAC use is increasing with time; real-world data may help to guide optimization of the care of complex patients.

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