Quality of clinical Direct Oral Anticoagulants (DOACs) prescribing and identification of risk factors for inappropriate prescriptions

AIMS: 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.

METHOD: A retrospective study in a non-university 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 eight criteria by using a modified version of the Medication Appropriateness Index (MAI).

RESULTS: A total of 770 initial DOAC prescriptions of inpatients were evaluated: 267 patients (34.6%) had at least met one inappropriate criterion for a DOAC prescription. The most frequent inappropriate criterion was 'dosage' (17.4%). Of all the four DOACs, dabigatran (21.6%) and apixaban (21.2%) were mostly inappropriate dosed. In a multivariable analysis, reduced renal function (eGFR < 50 mL/min) (OR=2.35; p<0.001), a diagnosis of atrial fibrillation (OR=1.87; p=0.004), and 'prescribed by surgeons' (OR=1.9; p=0.013) were independently associated with inappropriateness of prescribing.

CONCLUSION: This study has highlighted a high degree of inappropriate prescribing of DOACs. These results underline the need for targeted interventions to improve DOAC prescribing.