scholarly journals Determinants for under- and overdosing of direct oral anticoagulants and physicians' implementation of clinical pharmacists' recommendations

2021 ◽  
Author(s):  
Souad Moudallel ◽  
Pieter Cornu ◽  
Alain Dupont ◽  
Stephane Steurbaut
Keyword(s):  
Body Weight ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Inappropriate Prescribing ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Lower Odds ◽  
Clinical Pharmacists ◽  
Bleeding History

Aim: To analyze the appropriateness of DOAC dosing and determinants for under-and overdosing as well as acceptance and implementation rates of interventions by clinical pharmacists. Methods: Cross-sectional study from January 2019-December 2019 in a tertiary hospital in hospitalized patients with atrial fibrillation on DOACs (n=1688). Primary outcome was the proportion of patients with inappropriate DOAC prescribing with identification of determinants for under-and overdosing. Secondary outcomes included acceptance and implementation rates of pharmacists’ advices and determination of reasons for non-acceptance/non-implementation. Results: In 16.9% of patients, inappropriate prescribing was observed. For all DOACs considered together, body weight<60 kg(OR 0.46 [0.27-0.77]), edoxaban use(OR 0.42 [0.24-0.74]), undergoing surgery(OR 0.57 [0.37-0.87]) and being DOAC naïve(OR 0.45 [0.29-0.71]) were associated with a significantly lower odds of underdosing. Bleeding history(OR 1.86 [1.24-2.80]) and narcotic use(OR 1.67 [1.13-2.46]) were associated with a significantly higher odds for underdosing. Determinants with a significantly higher odds of overdosing were renal impairment(OR 11.29 [6.23-20.45]) and body weight<60 kg(OR 2.34 [1.42-3.85]), whereas the use of dabigatran(OR 0.24 [0.08-0.71]) and apixaban(OR 0.18 [0.10-0.32]) were associated with a significantly lower odds of overdosing compared to rivaroxaban. Physicians accepted the pharmacists’ advice in 179 cases (79.2%) consisting of 92 (51.4%) advices for underdosing, 82 (45.8%) for overdosing and 5 (2.8%) for contraindications. The advices were effectively implemented for 75 (81.5%) underdosed, 69 (84.1%) overdosed and 4 (80.0%) contraindicated cases. Conclusion: Inappropriate DOAC prescribing remains common. Clinical services led by pharmacists helps physicians to reduce the number of inadequate prescriptions for high risk medications such as DOACs.

scholarly journals The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years

2020 ◽  
Vol 17 (18) ◽  
pp. 6685
Author(s):  
Patrick Manckoundia ◽  
Clémentine Rosay ◽  
Didier Menu ◽  
Valentine Nuss ◽  
Anca-Maria Mihai ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Platelet Aggregation Inhibitors ◽  
Cross Sectional Study ◽  
Very Elderly ◽  
Cross Sectional ◽  
Aggregation Inhibitors ◽  
Cardiovascular Medications

We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for prescribed VKA in September 2017. The VKA and noVKA groups were compared in terms of demographic conditions, registered chronic diseases (RCD), number of drugs per prescription and cardiovascular medications. The three VKA subgroups were compared for the same items plus laboratory monitoring, novel and refill VKA prescriptions, and prescriber specialty. Of the 8696 included individuals, 1157 (13.30%) were prescribed VKA. Mean age was 90 years. The noVKA group had fewer women (53.67 vs 66.08%), more RCD (93.43 vs. 71.96%) and more drugs per prescription (6.65 vs. 5.18) than the VKA group (all p < 0.01). Except for direct oral anticoagulants and platelet aggregation inhibitors, the VKA group took significantly more cardiovascular medications. The most commonly prescribed VKA was fluindione (59.46%). Mean age was higher in the warfarin (90.42) than in the acenocoumarol (89.83) or fluindione (89.71) subgroups (p < 0.01). No differences were observed for sex (women were predominant) or RCD. 13% of subjects in this population had a VKA prescription. Fluindione was the most commonly prescribed VKA.

scholarly journals A Survey on the Awareness and Attitude of Physicians on Direct Oral Anticoagulants in Qatar

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 255S-260S ◽  
Author(s):  
Ahmed El-Bardissy ◽  
Hazem Elewa ◽  
Shaban Mohammed ◽  
Ahmed Shible ◽  
Rizwan Imanullah ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Inappropriate Prescribing ◽  
Positive Influence ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Professional Characteristics ◽  
Education Campaigns ◽  
Future Work ◽  
Significant Positive Influence

Direct oral anticoagulants (DOACs) are more commonly prescribed since their introduction. Reports on inappropriate prescribing have been observed which may indicate poor awareness on these agents. In this study, we aim to evaluate the extent of the physicians’ knowledge on DOACs and its possible impact on physicians’ confidence to prescribe these medications. A prospective cross-sectional survey was developed based on the literature review. Eligible participants were physicians and surgeons currently practicing at Hamad General Hospital in Qatar. The survey included questions on demographic and professional characteristics. It also evaluated the awareness and attitudes regarding safety, efficacy, and prescribing of DOACs. Over 6-month period, 175 practitioners responded to the survey. Overall awareness score was moderate (61% ± 18%). These scores were in alignment with participants’ self-satisfaction with knowledge on DOACs (66% were not satisfied) and participants’ confidence toward prescribing DOACs (48% were not confident). Age, degree of education, and years of experience had significant positive influence on awareness score. This survey indicates that practitioners have moderate awareness on DOACs. Future work should focus on reassessing practitioners’ knowledge after providing well-designed education campaigns

scholarly journals Prescription patterns of direct oral anticoagulants and concomitant use of interacting medications in the Netherlands

2021 ◽  
Author(s):  
R. E. Harskamp ◽  
J. C. L. Himmelreich ◽  
G. W. M. Wong ◽  
M. Teichert
Keyword(s):  
The Netherlands ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cross Sectional Study ◽  
Eastern Region ◽  
Cross Sectional ◽  
Organ Systems ◽  
Number Of Patients ◽  
Antiarrhythmic Medications ◽  
Over Time

Abstract Objectives To describe the prevalence, temporal and regional trends in prescribing direct oral anticoagulants (DOACs) in conjunction with interacting medications. Methods We performed a cross-sectional study of pharmacy dispensing data in the Foundation for Pharmaceutical Statistics (SFK) registry on patients who have had a prescription for a DOAC filled at one of 831 randomly selected pharmacies in the Netherlands between Jan 2014–Jan 2019. Results We identified 99,211 patients who had a first DOAC prescription filled. Mean age was 71.6 ± 10.9 years, 58% were male. In 2014, 8,293 patients were treated with DOACs, in 2018, 35,415 were newly started on a DOAC. In 2018, the use of apixaban was most common (52%) in the Eastern region, whereas rivaroxaban was most frequently prescribed (32–48%) in the other regions. At time of first prescription, the vast majority (99.3%) used ≥ 1 concomitant interacting drug, and 3.2% used ≥ 3 interacting medications. Most common were digoxin (37.8%), atorvastatin (31.5%), verapamil (13.7%) and amiodarone (9.7%). While the number of interacting medications remained unchanged over time (median 1, interquartile range 1–1), there was a notable decrease in antiarrhythmic medications and an increase in non-cardiovascular interacting medications (e.g. dexamethasone from 0.9% to 7.1%, antiepileptic drugs from 2.5% to 3.8%, and haloperidol from 0.5% to 2.2% in 2014 and 2018, respectively). Conclusion DOAC use has quadrupled in Dutch clinical practice over the 5‑year period from 2014 to 2018. While the number of patients who take interacting medications remained stable, the profile of interacting medications has changed over time from cardiovascular to medications affecting other organ systems.

scholarly journals Survey of Knowledge and Attitude of Pharmacists about Direct Oral Anticoagulants: A Cross-Sectional Study

2021 ◽  
Author(s):  
Zahra Vakili ◽  
Fatemeh Heydarpour ◽  
Foroud Shahbazi
Keyword(s):  
Health Care Professionals ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cross Sectional Study ◽  
Demographic Characteristics ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Mean ◽  
Knowledge And Attitude ◽  
Different Levels

Background: Direct oral anticoagulants (DOACs) are increasingly used due to fewer side effects, predictable pharmacokinetics, lower potential for drug interactions. Different levels of awareness among health care professionals have been reported. Methods: The main objectives of this study were to investigate the knowledge and attitude of pharmacists about direct oral anticoagulants. The present study was a descriptive cross-sectional study performed in Kermanshah province, Iran. The validated researcher-made questionnaire included questions about demographic characteristics and specialized questions that assessed the knowledge and attitude of pharmacists towards new oral anticoagulants.             Results: Out of 126 pharmacists participating in this study, 67 (53.2%) were male. The mean scores of knowledges and attitude in pharmacists were 64.94±5.84 and 28.62±3.98, respectively. The most common oral anticoagulant with a direct effect dispensed by pharmacists was rivaroxaban (77.4%). There was also a significant relationship between pharmacists' attitudes and their place of activity (P = 0.024). Conclusion: The results of this study showed that pharmacists had an acceptable knowledge and low attitude about DOACs.

scholarly journals Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients Aged 80 Years and Older

2021 ◽  
Vol 18 (9) ◽  
pp. 4443
Author(s):  
Patrick Manckoundia ◽  
Gilles Nuemi ◽  
Arthur Hacquin ◽  
Didier Menu ◽  
Clémentine Rosay ◽  
...  
Keyword(s):  
Vitamin K ◽  
Kidney Diseases ◽  
Angiotensin Receptor Blockers ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Severe Heart Failure ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Receptor Blockers

The effectiveness of direct oral anticoagulants (DOAC) is non-inferior to vitamin K antagonists (VKA) to treat atrial fibrillation and venous thromboembolism (VTE). In this cross-sectional study, we compared older persons taking DOACs to those taking VKAs. We included ambulatory individuals ≥80 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for a medical prescription in September 2017. The demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs were compared in the DOAC group and VKA group. Of the 3190 included individuals, 1279 (40%) were prescribed DOACs and 1911 (60%) VKAs. Individuals taking VKAs were older than those taking DOACs (87.11 vs. 86.35 years). In the DOAC group, there were more women (51.92% vs. 48.25%) (p = 0.043), less RCD (89.60% vs. 92.73%) (p = 0.002), less VTE (1.80% vs. 6.59%), less severe heart failure (58.09% vs. 67.87%), less severe hypertension (18.22% vs. 23.60%), less severe kidney diseases (1.49% vs. 3.82%), and fewer drugs per prescription (6.15 vs. 6.66) (p < 0.01 for all). The DOAC group were also less likely to be taking angiotensin receptor blockers (10.79% vs. 13.97%), furosemide (40.81% vs. 49.66%) or digoxin (10.32% vs. 13.66%) than the VKA group (p = 0.009, p < 0.001, and p = 0.005). DOACs were less prescribed than VKAs. Individuals taking VKAs were older and had more severe comorbidities and more drugs per prescription than those taking DOACs.

scholarly journals Automated Thrombin Generation Assay for Rivaroxaban, Apixaban, and Edoxaban Measurements

2021 ◽  
Vol 8 ◽  
Author(s):  
Tamana Meihandoest ◽  
Jan-Dirk Studt ◽  
Adriana Mendez ◽  
Lorenzo Alberio ◽  
Pierre Fontana ◽  
...  
Keyword(s):  
Thrombin Generation ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Strong Association ◽  
Area Under The Curve ◽  
Lag Time ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Thrombin Generation Assay ◽  
Drug Concentrations

Background: The thrombin generation assay (TG) is a promising approach to measure the degree of anticoagulation in patients treated with direct oral anticoagulants (DOAC). A strong association with plasma drug concentrations would be a meaningful argument for the potential use to monitor DOAC.Objectives: We aimed to study the correlation of TG with rivaroxaban, apixaban, and edoxaban drug concentrations in a large, prospective multicenter cross-sectional study.Methods: Five-hundred and fifty-nine patients were included in nine tertiary hospitals. The Technothrombin® TG was conducted in addition to an anti-Xa assay; LC-MS/MS was performed as the reference standard.Results: Correlation (rs) between thrombin generation measurements and drug concentrations was −0.72 for peak thrombin generation (95% confidence interval, CI, −0.77, −0.66), −0.55 for area under the curve (AUC; 95% CI −0.61, −0.48), and 0.80 for lag time (95% CI 0.75, 0.84). In contrast, rs was 0.96 with results of the anti-Xa activity (95% CI 0.95–0.97). Sensitivity with regard to the clinically relevant cut-off value of 50 μgL−1 was 49% in case of peak thrombin generation (95% CI, 44, 55), 29% in case of AUC (95% CI, 24, 34), and 64% in case of lag time (95% CI, 58, 69). Sensitivity of the anti-Xa assay was 95% (95% CI, 92, 97).Conclusions: The correlation of thrombin generation measurements with DOAC drug concentrations was weak, and clinically relevant drug levels were not predicted correctly. Our results do not support an application of TG in the monitoring of DOAC.

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