PMID- 28331354
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 1178-7074 (Print)
IS  - 1178-7074 (Electronic)
IS  - 1178-7074 (Linking)
VI  - 10
DP  - 2017
TI  - Utilization and prescribing patterns of direct oral anticoagulants.
PG  - 87-94
LID - 10.2147/IJGM.S129235 [doi]
AB  - BACKGROUND: Scant literature exists evaluating utilization patterns for direct 
      oral anticoagulants (DOACs). OBJECTIVES: The primary objective was to assess DOAC 
      prescribing in patients with venous thromboembolism (VTE) and nonvalvular atrial 
      fibrillation (NVAF) in outpatient clinics. Secondary objectives were to compare 
      utilization between family medicine (FM) and internal medicine (IM) clinics, 
      characterize potentially inappropriate use, and identify factors associated with 
      adverse events (AEs). METHODS: This was a retrospective cohort study of adults 
      with NVAF or VTE who received a DOAC at FM or IM clinics between 10/19/2010 and 
      10/23/2014. Descriptive statistics were utilized for the primary aim. Fisher's 
      exact test was used to evaluate differences in prescribing using an adapted 
      medication appropriateness index. Logistic regression evaluated factors 
      associated with inappropriate use and AEs. RESULTS: One-hundred twenty patients 
      were evaluated. At least 1 inappropriate criterion was met in 72 patients 
      (60.0%). The most frequent inappropriate criteria were dosage (33.0%), duration 
      of therapy (18.4%), and correct administration (18.0%). Apixaban was dosed 
      inappropriately most frequently. There was no difference in dosing 
      appropriateness between FM and IM clinics. The odds of inappropriate choice were 
      lower with apixaban compared to other DOACs (odds ratio [OR]=0.088; 95% 
      confidence interval [CI] 0.008-0.964; p=0.047). Twenty-seven patients (22.5%) 
      experienced an AE while on a DOAC, and the odds of bleeding doubled with each 
      inappropriate criterion met (OR=1.949; 95% CI 1.190-3.190; p=0.008). CONCLUSION: 
      Potentially inappropriate prescribing of DOACs is frequent with the most common 
      errors being dosing, administration, and duration of therapy. These results 
      underscore the importance of prescriber education regarding the appropriate use 
      and management of DOACs.
FAU - Whitworth, Maegan M
AU  - Whitworth MM
AD  - Department of Pharmacy Practice, Texas Tech University Health Sciences Center 
      (TTUHSC) School of Pharmacy.
FAU - Haase, Krystal K
AU  - Haase KK
AD  - Department of Pharmacy Practice, Texas Tech University Health Sciences Center 
      (TTUHSC) School of Pharmacy.
FAU - Fike, David S
AU  - Fike DS
AD  - Department of Pharmacy Practice, Texas Tech University Health Sciences Center 
      (TTUHSC) School of Pharmacy.
FAU - Bharadwaj, Ravindra M
AU  - Bharadwaj RM
AD  - Department of Internal Medicine.
FAU - Young, Rodney B
AU  - Young RB
AD  - Department of Family and Community Medicine.
FAU - MacLaughlin, Eric J
AU  - MacLaughlin EJ
AD  - Department of Pharmacy Practice, Texas Tech University Health Sciences Center 
      (TTUHSC) School of Pharmacy; Departments of Family Medicine and Internal 
      Medicine, TTUHSC School of Medicine, Amarillo, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20170310
PL  - New Zealand
TA  - Int J Gen Med
JT  - International journal of general medicine
JID - 101515487
PMC - PMC5354547
OTO - NOTNLM
OT  - apixaban
OT  - atrial fibrillation
OT  - dabigatran
OT  - medication errors
OT  - rivaroxaban
OT  - venous thromboembolism
COIS- Disclosure This works was presented as a poster (Abst. #383) at the American 
      College of Clinical Pharmacy Global Conference, San Francisco, CA, 10/20/2015. 
      The authors report no other conflicts of interest in this work.
EDAT- 2017/03/24 06:00
MHDA- 2017/03/24 06:01
PMCR- 2017/03/10
CRDT- 2017/03/24 06:00
PHST- 2017/03/24 06:00 [entrez]
PHST- 2017/03/24 06:00 [pubmed]
PHST- 2017/03/24 06:01 [medline]
PHST- 2017/03/10 00:00 [pmc-release]
AID - ijgm-10-087 [pii]
AID - 10.2147/IJGM.S129235 [doi]
PST - epublish
SO  - Int J Gen Med. 2017 Mar 10;10:87-94. doi: 10.2147/IJGM.S129235. eCollection 2017.