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Inappropriate non-vitamin K antagonist oral anticoagulants prescriptions: be cautious with dose reductions

BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are prescribed to patients with atrial fibrillation (AF) to reduce the risk of stroke. Prescribing the correct dose warrants careful consideration of the prevailing dose criteria that differ per NOAC. Electronic systems are useful to i...

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Autores principales: Jacobs, M. S., van Hulst, M., Campmans, Z., Tieleman, R. G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bohn Stafleu van Loghum 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639841/
https://www.ncbi.nlm.nih.gov/pubmed/30949972
http://dx.doi.org/10.1007/s12471-019-1267-9
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author Jacobs, M. S.
van Hulst, M.
Campmans, Z.
Tieleman, R. G.
author_facet Jacobs, M. S.
van Hulst, M.
Campmans, Z.
Tieleman, R. G.
author_sort Jacobs, M. S.
collection PubMed
description BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are prescribed to patients with atrial fibrillation (AF) to reduce the risk of stroke. Prescribing the correct dose warrants careful consideration of the prevailing dose criteria that differ per NOAC. Electronic systems are useful to intercept prescriptions that are incorrect based on simple ‘primary’ criteria, for example dosing frequency and drug-drug interactions with concomitant medication. However, these systems do not take into account patient characteristics such as age, renal function or weight, which are crucial elements to determine the NOAC dose. METHODS: Our goal was to determine the appropriateness of all prescriptions, as compared with the product labelling approved by the European Medicines Agency, to address common pitfalls in prescribing NOACs. AF patients with a first NOAC prescription between January 2012 and December 2016 were identified from our electronic hospital information system (Martini Hospital, Groningen, the Netherlands). RESULTS: The study included 3,231 AF patients who had started on an NOAC; 10.7% received an inappropriate dose and the appropriateness of the prescription could not be determined in 14.1%. Underdosing and overdosing occurred in 5.4% and 4.5% of all prescriptions, respectively. A reduced-dose NOAC was a predictor for incorrect prescribing (odds ratio: 2.70, 95% confidence interval: 2.13–3.41). Patient factors were identified that predicted incorrect prescriptions for dabigatran and apixaban. CONCLUSION: An incorrect prescription occurred more often in the reduced-dose NOAC group. Clinical parameters such as renal function are often unknown whilst these are essential to determine the right NOAC and dose. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12471-019-1267-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-66398412019-08-01 Inappropriate non-vitamin K antagonist oral anticoagulants prescriptions: be cautious with dose reductions Jacobs, M. S. van Hulst, M. Campmans, Z. Tieleman, R. G. Neth Heart J Original Article BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are prescribed to patients with atrial fibrillation (AF) to reduce the risk of stroke. Prescribing the correct dose warrants careful consideration of the prevailing dose criteria that differ per NOAC. Electronic systems are useful to intercept prescriptions that are incorrect based on simple ‘primary’ criteria, for example dosing frequency and drug-drug interactions with concomitant medication. However, these systems do not take into account patient characteristics such as age, renal function or weight, which are crucial elements to determine the NOAC dose. METHODS: Our goal was to determine the appropriateness of all prescriptions, as compared with the product labelling approved by the European Medicines Agency, to address common pitfalls in prescribing NOACs. AF patients with a first NOAC prescription between January 2012 and December 2016 were identified from our electronic hospital information system (Martini Hospital, Groningen, the Netherlands). RESULTS: The study included 3,231 AF patients who had started on an NOAC; 10.7% received an inappropriate dose and the appropriateness of the prescription could not be determined in 14.1%. Underdosing and overdosing occurred in 5.4% and 4.5% of all prescriptions, respectively. A reduced-dose NOAC was a predictor for incorrect prescribing (odds ratio: 2.70, 95% confidence interval: 2.13–3.41). Patient factors were identified that predicted incorrect prescriptions for dabigatran and apixaban. CONCLUSION: An incorrect prescription occurred more often in the reduced-dose NOAC group. Clinical parameters such as renal function are often unknown whilst these are essential to determine the right NOAC and dose. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12471-019-1267-9) contains supplementary material, which is available to authorized users. Bohn Stafleu van Loghum 2019-04-04 2019-07 /pmc/articles/PMC6639841/ /pubmed/30949972 http://dx.doi.org/10.1007/s12471-019-1267-9 Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Jacobs, M. S.
van Hulst, M.
Campmans, Z.
Tieleman, R. G.
Inappropriate non-vitamin K antagonist oral anticoagulants prescriptions: be cautious with dose reductions
title Inappropriate non-vitamin K antagonist oral anticoagulants prescriptions: be cautious with dose reductions
title_full Inappropriate non-vitamin K antagonist oral anticoagulants prescriptions: be cautious with dose reductions
title_fullStr Inappropriate non-vitamin K antagonist oral anticoagulants prescriptions: be cautious with dose reductions
title_full_unstemmed Inappropriate non-vitamin K antagonist oral anticoagulants prescriptions: be cautious with dose reductions
title_short Inappropriate non-vitamin K antagonist oral anticoagulants prescriptions: be cautious with dose reductions
title_sort inappropriate non-vitamin k antagonist oral anticoagulants prescriptions: be cautious with dose reductions
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639841/
https://www.ncbi.nlm.nih.gov/pubmed/30949972
http://dx.doi.org/10.1007/s12471-019-1267-9
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