Drug Use Review and Dose Appropriateness of New Oral Anticoagulants in Outpatients at Srinagarind Hospital
Keywords:
New oral anticoagulants (NOACs); drugs utilization review; potential drug-drug interactionsAbstract
Background and Objective: New oral anticoagulants (NOACs) is the new option of antithrombotics that contains several advantages over the warfarin use, however accumulating reports have shown some limitations or dose inappropriateness from its use. This study aimed to review the drug pattern and dose appropriateness of NOACs use during 1 year in outpatients at Srinagarind hospital.
Methods: The study was retrospective descriptive design. Data were collected from electronic database and medical records of patients who started NOACs using during December 2012 - December 2016.
Results: There were 103 cases with 475 prescriptions of NOACs use. The indications were nonvalvular atrial fibrillation (to reduce the risk of ischemic stroke and systemic embolism) for 75 cases (72.1%), and treatment and prevention of venous thromboembolism for 20 cases (19.2%) and 8 cases (7.7%), respectively. There was 1 case (1%) of off-label indication use for peripheral artery disease. The most prescribed NOACs was rivaroxaban (229 prescriptions, 48%), while the second and third were dabigatran (162 prescriptions, 34%) and apixaban (84 prescriptions, 18%). The three most prescribed of NOACs dosage regimen were dabigatran 110 mg twice daily (144 prescriptions, 30.3%), rivaroxaban 20 mg once daily (126 prescriptions, 26.5%), and rivaroxaban 15 mg once daily (96 prescriptions, 20.2%). Approximately 76% of patients were assessed renal function before starting NOACs, while 66% of patients were monitored renal function at least one time during NOACs use. Potential drug-drug interactions were found in 48 cases (46.6%) with 68 drug pairs. Most of them was concomitant use with antiplatelets (38.2%). The inappropriateness dose of NOACs were found in 22% of prescriptions which contains too low dose, too high dose, and contraindication use for 10%, 8% and 4%, respectively.
Conclusion: Most of NOACs use in outpatients at Srinagarind hospital was appropriate in terms of indication, dose and renal function monitoring. However, the lack of renal assessment/monitoring and the use in inappropriate dose were still found in some patients. Increasing awareness and management of NOACs utilization by healthcare team is suggested to improve the effectiveness of drug use in patients.
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