Identification of risk factors for inappropriate and suboptimal initiation of direct oral anticoagulants

Molly Howard, Andrew Lipshutz, Breanne Roess, Emily Hawes, Zachariah Deyo, Jena Ivey Burkhart, Stephan Moll, Betsy Bryant Shilliday

Research output: Research - peer-reviewArticle

  • 2 Citations

Abstract

Direct Oral Anticoagulants (DOACs) require specific dosing and monitoring to ensure safe and appropriate use. The purpose of this evaluation was to identify patient- and process-related factors that correlate with increased risk of inappropriate prescribing of DOACs. A retrospective chart review was conducted in three outpatient clinics within an academic medical center to identify patients started on DOAC therapy and evaluate the appropriateness of DOAC initiation. Data collected included patient demographics, DOAC medication initiated, dose, indication, baseline laboratory values, concomitant medications, type and specialty of prescriber, and initiation setting. Appropriateness of initial dose was assessed and data were analyzed in order to identify factors correlating with inappropriate use. One-hundred sixty-seven patients initiated on a DOAC were identified. Most patients were prescribed anticoagulation for atrial fibrillation (74.9 %) and most commonly prescribed rivaroxaban (62.9 %). An inappropriate dose was prescribed in 24 (14.4 %) patients. Female patients and patients over 75 years were more likely to be prescribed an inappropriate initial dose. Baseline evaluation of blood counts and organ function were often not performed: hemoglobin values had not been drawn within the month prior to initiation in 28.7 % of patients, serum creatinine in 22.8 %, alanine transaminase in 52.1 %, and total bilirubin in 64.1 %. Lack of baseline labs was more pronounced in patients initiated on a DOAC in the outpatient setting. Dosing and baseline lab collection for DOAC initiation were suboptimal in all settings analyzed. Targeted interventions are needed to ensure the safe and appropriate use of DOAC therapy.

LanguageEnglish (US)
Pages149-156
Number of pages8
JournalJournal of Thrombosis and Thrombolysis
Volume43
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Anticoagulants
Therapeutics
Inappropriate Prescribing
Ambulatory Care Facilities
Alanine Transaminase
Bilirubin
Atrial Fibrillation
Creatinine
Hemoglobins
Outpatients
Demography
Serum
Rivaroxaban

Keywords

  • Direct oral anticoagulants
  • Initiation
  • New oral anticoagulants
  • Prescribing
  • Risk factors
  • Target specific oral anticoagulants

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Identification of risk factors for inappropriate and suboptimal initiation of direct oral anticoagulants. / Howard, Molly; Lipshutz, Andrew; Roess, Breanne; Hawes, Emily; Deyo, Zachariah; Burkhart, Jena Ivey; Moll, Stephan; Shilliday, Betsy Bryant.

In: Journal of Thrombosis and Thrombolysis, Vol. 43, No. 2, 01.02.2017, p. 149-156.

Research output: Research - peer-reviewArticle

Howard M, Lipshutz A, Roess B, Hawes E, Deyo Z, Burkhart JI et al. Identification of risk factors for inappropriate and suboptimal initiation of direct oral anticoagulants. Journal of Thrombosis and Thrombolysis. 2017 Feb 1;43(2):149-156. Available from, DOI: 10.1007/s11239-016-1435-3
Howard, Molly ; Lipshutz, Andrew ; Roess, Breanne ; Hawes, Emily ; Deyo, Zachariah ; Burkhart, Jena Ivey ; Moll, Stephan ; Shilliday, Betsy Bryant. / Identification of risk factors for inappropriate and suboptimal initiation of direct oral anticoagulants. In: Journal of Thrombosis and Thrombolysis. 2017 ; Vol. 43, No. 2. pp. 149-156
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