Jacobs M S, van Hulst M, Campmans Z, Tieleman R G
Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands.
Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), University of Groningen, Groningen, The Netherlands.
Neth Heart J. 2019 Jul;27(7-8):371-377. doi: 10.1007/s12471-019-1267-9.
Non-vitamin K antagonist oral anticoagulants (NOACs) are prescribed to patients with atrial fibrillation (AF) to reduce the risk of stroke. Prescribing the correct dose warrants careful consideration of the prevailing dose criteria that differ per NOAC. Electronic systems are useful to intercept prescriptions that are incorrect based on simple 'primary' criteria, for example dosing frequency and drug-drug interactions with concomitant medication. However, these systems do not take into account patient characteristics such as age, renal function or weight, which are crucial elements to determine the NOAC dose.
Our goal was to determine the appropriateness of all prescriptions, as compared with the product labelling approved by the European Medicines Agency, to address common pitfalls in prescribing NOACs. AF patients with a first NOAC prescription between January 2012 and December 2016 were identified from our electronic hospital information system (Martini Hospital, Groningen, the Netherlands).
The study included 3,231 AF patients who had started on an NOAC; 10.7% received an inappropriate dose and the appropriateness of the prescription could not be determined in 14.1%. Underdosing and overdosing occurred in 5.4% and 4.5% of all prescriptions, respectively. A reduced-dose NOAC was a predictor for incorrect prescribing (odds ratio: 2.70, 95% confidence interval: 2.13-3.41). Patient factors were identified that predicted incorrect prescriptions for dabigatran and apixaban.
An incorrect prescription occurred more often in the reduced-dose NOAC group. Clinical parameters such as renal function are often unknown whilst these are essential to determine the right NOAC and dose.
非维生素K拮抗剂口服抗凝药（NOACs）被用于心房颤动（AF）患者以降低中风风险。开具正确剂量需要仔细考虑每种NOAC不同的现行剂量标准。电子系统有助于拦截基于简单“主要”标准（如给药频率以及与合并用药的药物相互作用）而开具的错误处方。然而，这些系统并未考虑患者特征，如年龄、肾功能或体重，而这些是确定NOAC剂量的关键因素。
我们的目标是根据欧洲药品管理局批准的产品标签确定所有处方的合理性，以解决开具NOAC时常见的陷阱。我们从电子医院信息系统（荷兰格罗宁根马提尼医院）中识别出2012年1月至2016年12月首次开具NOAC处方的AF患者。
该研究纳入了3231例开始使用NOAC的AF患者；10.7%的患者接受了不适当剂量，14.1%的处方合理性无法确定。所有处方中，剂量不足和剂量过量分别占5.4%和4.5%。低剂量NOAC是开具错误处方的一个预测因素（比值比：2.70，95%置信区间：2.13 - 3.41）。确定了预测达比加群和阿哌沙班开具错误处方的患者因素。
低剂量NOAC组开具错误处方的情况更常见。肾功能等临床参数往往未知，而这些对于确定正确的NOAC和剂量至关重要。
