scholarly journals Enhancement and evaluation of a prescription audit system for direct oral anticoagulants using a check sheet

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naoto Ishikawa ◽  
Hanae Oshikiri ◽  
Shinya Takasaki ◽  
Masafumi Kikuchi ◽  
Taku Obara ◽  
...  
Keyword(s):  
Dose Reduction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Optimal Dose ◽  
University Hospital ◽  
Audit System ◽  
Prescription Audit ◽  
Dosage Regimens ◽  
Patient’S Information ◽  
Concomitant Medications

Abstract Background Renal function and use of concomitant medications should be carefully monitored in patients subjected to treatment with direct oral anticoagulants (DOACs); the dose should be individually designed for each patient. Owing to the complex therapeutic indications and dose reduction criteria, pharmacists exercise caution when determining the optimal dose for each patient. A DOAC check sheet has been developed that is automatically printed in the dispensing room at the same time as the prescription and can be used by pharmacists to dispense DOACs promptly and correctly. The purpose of this study was to evaluate the system for dispensing DOACs using a check sheet. Methods The study was conducted at Tohoku University Hospital in Japan; prescriptions containing DOACs dispensed by the hospital pharmacists were evaluated. The DOAC check sheet described indications, dosage regimens, dose reduction criteria, and contraindications for each drug and included the patient’s information. The check sheet was set to print automatically in the dispensing room at the same time as the prescription when an inpatient was prescribed DOACs. This check sheet was evaluated using a prescription survey and a questionnaire for pharmacists. Results The usefulness of this check sheet for the correct use of DOACs was evaluated. There were four inquiries out of 642 (0.6%) prescriptions from pharmacists to physicians regarding DOAC prescriptions, such as the dose introduced before DOAC check sheet utilization, and there were 21 out of 905 (2.3%) prescriptions when the DOAC check sheet was used it, showing a significant increase (p = 0.0089). After the introduction of this sheet, overdoses of DOACs were identified at the time of dispensing. Of the 52 pharmacists who responded to the questionnaire, 51 (98%) stated that the check sheet was useful. Conclusion The use of the DOAC check sheet is likely to render safety to DOAC drug therapy for individual patients.

Risk Factors for Post-Thrombotic Syndrome in Patients With a First Proximal Deep Venous Thrombosis Treated With Direct Oral Anticoagulants

Angiology ◽  
2022 ◽  
pp. 000331972110708
Author(s):  
Luca Spiezia ◽  
Elena Campello ◽  
Chiara Simion ◽  
Anna Poretto ◽  
Fabio Dalla Valle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
University Hospital ◽  
First Episode ◽  
Minimum Period ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Age Range ◽  
Deep Vein

The incidence of post-thrombotic syndrome (PTS) in patients with deep vein thrombosis (DVT) treated with direct oral anticoagulants (DOACs) remains a matter of debate. Hence, our endeavor to investigate a large cohort of patients with a first episode of proximal DVT treated with DOACs to ascertain the incidence and predisposing risk factors for PTS. All consecutive patients referred to the Thrombotic and Haemorrhagic Diseases Unit of Padova University Hospital (Italy) between January 2014 and January 2018 for a first episode of proximal DVT were considered for enrollment. Participants received DOACs for a minimum period of 3 months. PTS was assessed using the Villalta score up to 36 months after DVT diagnosis. Among 769 enrolled patients (M/F 353/416, age range 26–87 years), 152 (19.8%) developed PTS and 30 (3.9%) developed severe PTS. The adjusted hazard ratio was significant for obesity (1.64, 95% CI 1.28–2.39) and DVT site (femoral and/or iliac veins vs popliteal vein) (1.23, 95% CI 1.15–3.00). The incidence of PTS is not negligible in patients with proximal DVT despite the use of DOACs. We identified obesity and iliofemoral DVT as possible risk factors for PTS. Larger prospective studies are needed to confirm our findings and optimize therapeutic strategies.

Dose reduction of edoxaban preserves efficacy and safety for the treatment of venous thromboembolism

2016 ◽  
Vol 116 (10) ◽  
pp. 747-753 ◽  
Author(s):  
Philip S. Wells ◽  
Annelise Segers ◽  
Walter Ageno ◽  
Marjolein P. A. Brekelmans ◽  
Alexander T. Cohen ◽  
...  
Keyword(s):  
Body Weight ◽  
Venous Thromboembolism ◽  
Dose Reduction ◽  
Drug Exposure ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Efficacy And Safety ◽  
P Glycoprotein ◽  
Recurrent Vte ◽  
Glycoprotein Inhibitors

SummaryDirect oral anticoagulants simplify venous thromboembolism (VTE) treatment by obviating the need for coagulation monitoring. Nonetheless, renal function, body weight and P-glycoprotein inhibitors influence drug levels. The objective of this analysis was to determine whether reduction in edoxaban dose based on clinical criteria avoids excess drug exposure and preserves efficacy and safety in the Hokusai-VTE study. After initial heparin, patients received edoxaban or warfarin for 3-12 months. Edoxaban was given once daily at a dose of 60 mg, which was reduced to 30 mg in patients with a creatinine clearance of 30–50 ml/minute, body weight ≤60 kg or receiving certain P-glycoprotein inhibitors. The primary efficacy outcome was recurrent VTE and the principal safety outcome was major or clinically relevant non-major bleeding. A total of 8292 patients with acute VTE were randomised, 733 and 719 patients in the edoxaban and warfarin groups met the criteria for dose reduction. These patients were older, more often female or Asian and had more extensive VTE. Edoxaban levels were lower in the 30 mg edoxaban group. Rates of recurrent VTE and bleeding with the 30 mg and 60 mg edoxaban dose were comparable: VTE rates were 3.0 % and 3.2 % and clinically relevant bleeding rates were 7.9 % and 8.6 %, respectively. Rates of recurrent VTE and bleeding in the warfarin-treated patients meeting the criteria for dose reduction were 4.2 % and 12.8 %, respectively. The reduced dose edoxaban regimen maintained efficacy and safety compared with the 60 mg dose but was safer than warfarin in patients meeting the criteria for dose reduction.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals The role of edoxaban in preventing thromboembolic complications in patients with atrial fibrillation

2020 ◽  
pp. 28-43
Author(s):  
O. O. Shakhmatova
Keyword(s):  
Atrial Fibrillation ◽  
Drug Interactions ◽  
Dose Reduction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Extensive Study ◽  
Thromboembolic Complications ◽  
Nonvalvular Atrial Fibrillation ◽  
Life Threatening

Edoxaban is a selective direct factor Xa inhibitor. Edoxaban in a dose of 60 mg per day is an effective and safe option in the prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation, including in combination therapy in patients after percutaneous coronary interventions. ENGAGE AF-TIMI 48 is currently the most extensive study comparing direct oral anticoagulants and warfarin in patients with atrial fibrillation, both in terms of number of participants and duration of observation. For edoxaban, an adequate approach to dose reduction has been developed in patients with alikely increase in plasma concentration due to renal impairment, low body weight or inter-drug interactions. Such dose reduction does notlead to an increase in the frequency of ischemic complications.Edoxaban is characterized by an optimal safety profile in patients with chronic moderate kidney disease, a small number of drug interactions and a convenient mode of administration. In patients with atrial fibrillation and concomitant ischemic heart disease, the use of Edoxaban is associated with a decrease in the frequency of myocardial infarctions, as well as strokes and episodes of systemic thromboembolism in comparison with warfarin. The drug can be successfully used as anticoagulant support for cardioversion and catheter ablation for atrial fibrillation.Edoxaban intake does not require routinelaboratory control. In case of unexpected situations (life-threatening bleeding, urgent surgical intervention) in patients receiving edoxaban, to assess the degree of anticoagulation should use the determination of anti-Xa activity. Clinical studies of a specific antidote of edoxaban - andexanet alfa are ongoing. Before approval of the specific antidote in severe andlife-threatening bleedings against the background of edoxaban administration, the use of prothrombin complex concentrate should be considered. Data on the effective and safe use of edoxaban in routine clinical practice have been accumulated.

DIRECT ORAL ANTICOAGULANTS: A COMPARISON OF EFFICACY AND SAFETY, ERRORS IN THEIR APPLICATION, AND THE USAGE OF REVERSAL AGENTS

2019 ◽  
Vol 25 (2) ◽  
pp. 127-134
Author(s):  
V. V Tarasov ◽  
Vladimir N. Chubarev ◽  
E. S Zykova ◽  
A. S Belosludtsev ◽  
E. G Mokshanova ◽  
...  
Keyword(s):  
Side Effects ◽  
Drug Interactions ◽  
Blood Clotting ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Study Drug ◽  
Efficacy And Safety ◽  
Reversal Agents ◽  
Dosage Regimens ◽  
Prevention And Treatment

This review is devoted to updating the existing knowledge about pharmacology of the drugs from the group of direct oral anticoagulants (DOACs). Special attention is paid to comparison of the anticoagulant properties of DOACs with traditional (indirect) anticoagulants at various dosage regimens and to study drug interactions of DOACs with drugs from different pharmacological groups. Widely analyzed the side effects associated with errors in the application of DOACs and provided recommendations for their correction, including the using of reversal agents therapy. Based on this, the presented article will be useful to clinicians to familiarize themselves with modern medical strategies based on the use of drugs from the DOACs group for the prevention and treatment of diseases associated with increased blood clotting ability and using of DOACs specific antagonists for treatment overdose of DOACs.

Evaluation of Potential Drug–Drug Interactions With Direct Oral Anticoagulants in a Large Urban Hospital

2018 ◽  
Vol 33 (2) ◽  
pp. 136-141 ◽  
Author(s):  
Yoonsun Mo ◽  
Ayse Karakas-Torgut ◽  
Antony Q. Pham
Keyword(s):  
Drug Interactions ◽  
Medical Center ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Potential Drug ◽  
Urban Hospital ◽  
Combined Use

Objective: The aim of this study is to assess patterns of potential drug–drug interactions (DDIs) with direct oral anticoagulants (DOACs) in an inpatient hospital setting. Methods: A retrospective chart review was conducted at the Brookdale University Hospital and Medical Center (BUHMC) from January 2014 to November 2016. All adult patients admitted to the BUHMC who were treated with a DOAC for at least 3 days were screened. Among them, those who received selected interacting drugs at any time during the course of DOAC therapy were included in this study. Results: This study included 165 patients with an average of 73 years (standard deviation [SD] = 12.3) and 233 cases. The most commonly used concomitant drug with a DOAC was aspirin (58%), followed by amiodarone (16%) and P2Y12 inhibitors (11%). The combined use of dual antiplatelet therapy and a DOAC was identified in 18 (6%) cases. Approximately one-third of the cases encountered were classified as the “avoidance” category. Conclusions: Despite computerized DDI alerts, potentially significant DDIs with DOACs still occur. While the present study provides insight into the current patterns of DDIs, further studies are needed to evaluate clinical outcomes of the potential DDIs with DOACs in practice.

scholarly journals Use of anticoagulants increases risk of bleeding after colorectal endoscopic submucosal dissection

2018 ◽  
Vol 06 (07) ◽  
pp. E857-E864 ◽  
Author(s):  
Ken Yamashita ◽  
Shiro Oka ◽  
Shinji Tanaka ◽  
Kazuki Boda ◽  
Daiki Hirano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Perioperative Period ◽  
University Hospital ◽  
En Bloc ◽  
Risk Of Bleeding ◽  
Warfarin Group ◽  
Submucosal Dissection ◽  
Clinical Records

Abstract Background and study aims Japanese guidelines for gastroenterological endoscopy have recommended temporary withdrawal of anticoagulants (warfarin, direct oral anticoagulants [DOAC], or heparin) to prevent hemorrhagic complications during endoscopic submucosal dissection (ESD) for colorectal neoplasias (CRNs). However, serious thrombosis might occur during temporary withdrawal of anticoagulants. The current study aimed to evaluate outcomes with anticoagulants in patients undergoing ESD for CRNs. Patients and methods This study was a single-institution retrospective cohort study based on clinical records. We assessed 650 consecutive patients with 698 CRNs who underwent ESD at Hiroshima University Hospital between December 2010 and June 2016. The patients were divided into three groups: the warfarin group (19 patients with 19 CRNs), DOAC group (7 patients with 9 CRNs), and no-antithrombotics group (624 patients with 670 CRNs). We replaced warfarin with heparin 3 to 5 days before endoscopy. Although DOAC was suspended on the morning of endoscopy, we did not replace heparin. Results Bleeding after the procedure occurred in 26.3 % (5/19), 22.0 % (2/9), and 2.7 % (18/670) of patients in the warfarin, DOAC, and no-antithrombotics groups, respectively. In the warfarin group, four patients who bled after the procedure took not only warfarin but also other antiplatelets. En bloc resection rates were 94.7 % (18/19), 100 % (9/9), and 96.6 % (647/670) in the warfarin, DOAC, and no-antithrombotics groups, respectively. No patients experienced ischemic events in the perioperative period. Conclusions Among patients undergoing ESD for CRNs, risk of bleeding was higher among patients who took anticoagulants than among those who did not. In particular, careful attention to patients who took antiplatelets in addition to warfarin before ESD for CRNs is warranted.

scholarly journals Gastrointestinal Bleeding During Direct Oral Anticoagulants Therapy in Patients With Nonvalvular Atrial Fibrillation and Risk of Polypharmacy

2022 ◽  
Author(s):  
Taku Honda ◽  
Koichiro Abe ◽  
Minoru Oda ◽  
Fumito Harada ◽  
Kyohei Maruyama ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Significant Risk ◽  
Nonvalvular Atrial Fibrillation ◽  
Oral Medications ◽  
Cerebrovascular Events ◽  
Concomitant Medications ◽  
Inverse Probability Weighted

Abstract Although concomitant medications have been raised as a factor affecting hemorrhage during direct oral anticoagulants (DOACs) therapy, details remain unelucidated. This study was conducted to clarify the relationship between concomitant medications with possible pharmacokinetic interactions and number of concomitant medications, and bleeding and embolism in patients with nonvalvular atrial fibrillation on DOACs. The subjects were 1,010 patients prescribed DOACs between April 2011 and June 2018. The study investigated their course between the first prescription and December 2018, including the presence or absence of clinically relevant bleeding, gastrointestinal bleeding (GIB), and major cardiovascular and cerebrovascular events (MACCE). Impacts of medications were evaluated by the general linear model with inverse probability-weighted propensity score. The observation period was 2,272 patient-years. The rate of bleeding was 4.7%/year, GIB was 2.8%/year, and MACCE was 2.0%/year. Taking 10 or more oral medications concurrently was a significant risk for GIB (hazard ratio, 2.046 [1.188–3.526]; p = 0.010). Nonsteroidal anti-inflammatory drugs (NSAIDs) was the only significant risk for GIB. Clinicians should be aware of gastrointestinal bleeding when using DOACs with patients taking more than 10 medications and/or NSAIDs.

scholarly journals Risks of postextraction bleeding after receiving direct oral anticoagulants or warfarin: a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015952 ◽  
Author(s):  
Takahiro Yagyuu ◽  
Mao Kawakami ◽  
Yoshihiro Ueyama ◽  
Mitsuhiko Imada ◽  
Miyako Kurihara ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cohort Analysis ◽  
Primary Outcome Measure ◽  
University Hospital ◽  
Tooth Extractions

ObjectiveThe effect of direct oral anticoagulants (DOACs) on the risk of bleeding after tooth extraction remains unclear. This study aimed to evaluate the incidence of postextraction bleeding among patients who received DOAC and vitamin K antagonists (VKAs), such as warfarin.DesignThis study was a retrospective cohort analysis. Incidence rates and propensity score-matched regression models were used to compare the risks of bleeding after tooth extractions involving DOACs and VKAs.SettingThe study took place in a single university hospital in Japan.ParticipantsBetween April 2013 and April 2015, 543 patients underwent a total of 1196 simple tooth extractions.Primary outcome measureThe primary outcome measure was the occurrence of postextraction bleeding, which was defined as bleeding that could not be stopped by biting down on gauze and required medical treatment between 30 min and 7 days after the extraction.ResultsA total of 1196 tooth extractions (634 procedures) in 541 patients fulfilled the study criteria, with 72 extractions (41 procedures) involving DOACs, 100 extractions (50 procedures) involving VKAs and 1024 extractions (543 procedures) involving no anticoagulants. The incidences of postextraction bleeding per tooth for the DOAC, VKA and no anticoagulant extractions were 10.4%, 12.0% and 0.9%, respectively. The incidences of postextraction bleeding per procedure for DOACs, VKAs and no anticoagulants were 9.7%, 10.0% and 1.1%, respectively. In comparison to the VKA extractions, the DOAC extractions did not significantly increase the risk of postextraction bleeding (OR 0.69, 95% CIs 0.24 to 1.97; p=0.49).ConclusionsThe risk of postextraction bleeding was similar for DOAC and VKA extractions.

scholarly journals Comparison of Effectiveness and Safety of Antiarrhythmic Drugs Class IC and III in Patients After Electrical Cardioversion

2019 ◽  
Vol 73 (1) ◽  
pp. 34-39
Author(s):  
Aldis Strēlnieks ◽  
Alberts Bērziņš ◽  
Māra Karakone ◽  
Irina Pupkeviča ◽  
Kristīne Jubele ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Direct Current ◽  
Antiarrhythmic Drugs ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Electrical Cardioversion ◽  
University Hospital ◽  
Recurrence Rates ◽  
Direct Current Cardioversion ◽  
Increased Risk

Abstract Patients with atrial fibrillation are faced with an increased risk of thromboembolic events, myocardial infarction, chronic heart failure and death. For some patients with atrial fibrillation, direct current cardioversion (DCCV) is a strategy that can be used to reacquire sinus rhythm. Our aim was to analyse the most commonly used medications after an electrical cardioversion, the reasons for not using them, the effects of pharmacotherapy on recurrence rates, and compare results with data from studies in 2014. The prospective study includes patients with electrocardiographically confirmed atrial fibrillation who underwent direct current cardioversion, hospitalised at Pauls Stradiņš Clinical University Hospital (Rīga, Latvia). The average age was 64.6 years. 50% of the patients were female. During the six-month study period, 14.3% patients were using amiodarone, 8.3% patients were on etacizine, 7.1% received propafenone, and 57.1% used beta blockers in monotherapy or in combination. Warfarin was used in 28.0% patients, direct oral anticoagulants (DOAC’s) in 29.9%, 21,4% of patients received aspirin and 16.7% did not use any antithrombotic therapy. Comparing the recurrence rate in patients using different antiarrhythmic drugs, amiodarone showed a statistically significant superiority compared to etacizine and propafenone (p = 0.02). The obtained data showed that over four years, the use of anticoagulants increased by 11.6%.

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