Dr. John Dougherty, Nkiru Anyagaligbob, Katerina Xub, & Sheldon Lefkowitzb
Purpose. This study assessed medication reconciliation, ordering, dispensing, and administration activities of apixaban, dabigatran, and rivaroxaban for venous thromboembolism (VTE) treatment and stroke risk reduction in patients with nonvalvular atrial fibrillation (AF).
Methods. The study was a retrospective, process improvement analysis of patients for whom apixaban, dabigatran or rivaroxaban was prescribed by a hospitalist at a large community hospital. Measures included appropriate DOAC dosing, appropriate management during transition from parenteral anticoagulant to DOAC, DOAC scheduling/administration compliance, inpatient DOAC dosing and significant drug interactions.
Results. The study included 98 patients, 52 females and 46 males. The mean age was 64.4 years old (range 20 to 100 years). DOAC indications included DVT (16), PE (26), and AF (56). There was delay in initiation of DOACs in all 8 patients administered UFH and 4 of the 5 patients administered enoxaparin.
Conclusions. The study results highlight gaps in compliance with the new NPSG for anticoagulation therapy. Educational efforts for hospitalists, pharmacists, and nurses will be initiated to improve their understanding of DOAC characteristics when ordering and administrating these medications.
