van der Horst S F B, van Rein N, van Mens T E, Huisman M V, Klok F A
Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, Netherlands.
Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.
Thromb Res. 2023 Nov;231:135-140. doi: 10.1016/j.thromres.2023.03.007. Epub 2023 Mar 27.
Direct oral anticoagulants (DOACs) have become the cornerstone for prevention of thromboembolic events in patients with atrial fibrillation and patients with a history of venous thromboembolism. However, studies show that DOAC prescriptions are commonly inconsistent with guideline recommendations. DOAC dosing in the acutely ill patient could impose an even greater challenge. In this review, we describe the prevalence of inappropriate inpatient prescribing of DOACs and the associated rationales, predictors and clinical consequences. With the aim of promoting appropriate prescriptions of DOACs to hospitalized patients, we further outline DOAC dose reduction criteria justified by various guidelines, illustrating the complexities of appropriate dosing, especially in acutely ill patients. Moreover, we will discuss the impact of anticoagulant stewardship programs and the vital role that pharmacists may play in optimizing inpatient DOAC treatment.
直接口服抗凝剂（DOACs）已成为预防心房颤动患者和有静脉血栓栓塞病史患者血栓栓塞事件的基石。然而，研究表明，DOAC的处方通常与指南建议不一致。在急性病患者中使用DOAC进行剂量调整可能带来更大的挑战。在本综述中，我们描述了DOAC在住院患者中不合理处方的发生率及其相关理由、预测因素和临床后果。为了促进对住院患者合理开具DOAC处方，我们进一步概述了各种指南所认可的DOAC剂量降低标准，阐明了合理给药的复杂性，尤其是在急性病患者中。此外，我们将讨论抗凝管理计划的影响以及药师在优化住院患者DOAC治疗中可能发挥的重要作用。
