Zhang Zhu Xian, van de Garde Ewoudt M W, Söhne Maaike, Harmsze Ankie M, van den Broek Marcel P H
Department of Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands.
Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Br J Clin Pharmacol. 2020 Aug;86(8):1567-1574. doi: 10.1111/bcp.14264. Epub 2020 Mar 13.
Even though the use of direct oral anticoagulants (DOACs) is safe based on clinical outcomes, drug safety also depends on appropriateness of drug prescription, which is challenging for DOACs since many patient factors need to be considered. The aim of this study was to assess the appropriateness of DOAC prescriptions and to identify risk factors of determinants for inappropriate DOAC prescriptions.
A retrospective study in a nonuniversity teaching hospital was performed of hospitalized patients (≥18 years) who received an initial DOAC prescription between February and August 2018. Appropriateness of prescribing was evaluated on 8 criteria by using a modified version of the medication appropriateness index.
A total of 770 initial DOAC prescriptions of inpatients were evaluated: 267 patients (34.6%) had at least met 1 inappropriate criterion for a DOAC prescription. The most frequent inappropriate criterion was dosage (17.4%). Of the 4 DOACs, dabigatran (21.6%) and apixaban (21.2%) were mostly inappropriate dosed. In a multivariable analysis, reduced renal function (estimated glomerular filtration rate <50 mL/min; odds ratio [OR] = 2.35; P < .001), a diagnosis of atrial fibrillation (OR = 1.87; P = .004), and 'prescribed by surgeons' (OR = 1.9; P = .013) were independently associated with inappropriateness of prescribing.
This study has highlighted a high degree of inappropriate prescribing of DOACs. These results underline the need for targeted interventions to improve DOAC prescribing.
尽管基于临床结果，直接口服抗凝剂（DOACs）的使用是安全的，但药物安全性还取决于药物处方的合理性，而这对DOACs来说具有挑战性，因为需要考虑许多患者因素。本研究的目的是评估DOAC处方的合理性，并确定DOAC处方不当的决定因素的风险因素。
对一家非大学教学医院2018年2月至8月期间接受初始DOAC处方的住院患者（≥18岁）进行回顾性研究。使用改良版药物合理性指数，根据8项标准评估处方的合理性。
共评估了770例住院患者的初始DOAC处方：267例患者（34.6%）至少符合1项DOAC处方的不当标准。最常见的不当标准是剂量（17.4%）。在4种DOACs中，达比加群（21.6%）和阿哌沙班（21.2%）的剂量大多不当。在多变量分析中，肾功能减退（估计肾小球滤过率<50 mL/分钟；比值比[OR]=2.35；P<.001）、房颤诊断（OR=1.87；P=.004）和“由外科医生开具”（OR=1.9；P=.013）与处方不当独立相关。
本研究突出了DOACs处方存在高度不当的情况。这些结果强调了需要采取有针对性的干预措施来改善DOAC处方。
