Is the Prescription Right? A Review of Non-vitamin K Antagonist Anticoagulant (NOAC) Prescriptions in Patients with Non-valvular Atrial Fibrillation. Safe Prescribing in Atrial Fibrillation and Evaluation of Non-vitamin K Oral Anticoagulants In...

Overview

Journal Ir J Med Sci

Specialty General Medicine

Date 2018 Jun 4

PMID 29860595

Citations 9

Authors

Rebabonye B Pharithi

Deepti Ranganathan

Jim OBrien

Emmanuel E Egom

Cathie Burke

Daniel Ryan

Christine McAuliffe

Marguerite Vaughan

Tara Coughlan

Edwina Morrissey

John McHugh

David Moore

Ronan Collins

Affiliations

Soon will be listed here.

Abstract

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are a major advance for stroke prevention in atrial fibrillation (AF). Use of the vitamin K antagonist (VKA), warfarin, has dropped 40% since 2010 in our institution. There is limited Irish hospital data on NOAC prescribing for stroke prevention.

Method: Single centre, retrospective observational cohort study of consecutive AF patients at increased risk of stroke and/or awaiting electrical cardioversion. Data on prescribed NOACs from February 2010 till July 2015 was collected from the electronic inpatient record. Appropriateness of prescriptions was based on CHA2DS2-VASC score and accuracy on individual NOAC SPCs. Potential drug interactions and bleeding risk were also quantified.

Results: A total of 348 patients AF and increased risk of stroke (CHA2DS2-VASC score > 1 for men and > 2 for women) were studied. Forty-eight percent were female with a mean age 71 ± 18.6 years, 52% of whom were > 75. Mean CHA2DS2-Vasc and HAS-BLED scores were 4.1 ± 1.8 and 1.4 ± 0.8, respectively. Rivaroxaban, dabigatran and apixaban were prescribed to 154 (54.2%), 106 (34.3%) and 41 (13.2%) patients, respectively. 20.4% had inaccurate prescriptions; 92.9% (n = 65) underdosed and 7.1% (n = 5) on inappropriately higher doses. Neither choice of NOAC, age, history of anaemia, previous bleeding or co-prescribed antiplatelets influenced the accuracy of prescription (p = NS), but decreased renal function appeared to do so (p = 0.05).

Conclusion: Our study highlights significant inaccuracies in NOAC prescribing. Patients commenced on NOACs should be assessed and followed up in a multidisciplinary AF clinic to ensure safe and effective prescribing and stroke prevention.

Citing Articles

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Appropriateness of rivaroxaban and apixaban dosing in hospitalized patients with a newly diagnosed nonvalvular atrial fibrillation at a single tertiary hospital.

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Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis.

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Prescribing Errors With Direct Oral Anticoagulants and Their Impact on the Risk of Bleeding in Patients With Atrial Fibrillation.

Raccah B, Erlichman Y, Pollak A, Matok I, Muszkat M J Cardiovasc Pharmacol Ther. 2021; 26(6):601-610.

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