Article ; Online: 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 stroke prevention (SAFE-NOACS) group.
Irish journal of medical science
2018 Volume 188, Issue 1, Page(s) 101–108
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 ... ...
| 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. |
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| MeSH term(s) | Administration, Oral ; Aged ; Aged, 80 and over ; Anticoagulants/administration & dosage ; Anticoagulants/therapeutic use ; Atrial Fibrillation/drug therapy ; Dabigatran/therapeutic use ; Female ; Humans ; Inappropriate Prescribing/statistics & numerical data ; Male ; Medical Audit ; Middle Aged ; Prescriptions/statistics & numerical data ; Pyrazoles/therapeutic use ; Pyridones/therapeutic use ; Retrospective Studies ; Rivaroxaban/therapeutic use ; Stroke/prevention & control | |||||
| Chemical Substances | Anticoagulants ; Pyrazoles ; Pyridones ; apixaban (3Z9Y7UWC1J) ; Rivaroxaban (9NDF7JZ4M3) ; Dabigatran (I0VM4M70GC) | |||||
| Language | English | |||||
| Publishing date | 2018-06-02 | |||||
| Publishing country | Ireland | |||||
| Document type | Journal Article ; Observational Study | |||||
| ZDB-ID | 390895-1 | |||||
| ISSN | 1863-4362 ; 0021-1265 | |||||
| ISSN (online) | 1863-4362 | |||||
| ISSN | 0021-1265 | |||||
| DOI | 10.1007/s11845-018-1837-7 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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