Abstract
BackgroundRenal function and use of concomitant medications should be carefully monitored in patients subjected to treatment with direct oral anticoagulants (DOACs); the dose should be individually designed for each patient. Owing to the complex therapeutic indications and dose reduction criteria, pharmacists exercise caution when determining the optimal dose for each patient. A DOAC check sheet has been developed that is automatically printed in the dispensing room at the same time as the prescription and can be used by pharmacists to dispense DOACs promptly and correctly. The purpose of this study was to evaluate the system for dispensing DOACs using a check sheet.MethodsThe study was conducted at Tohoku University Hospital in Japan; prescriptions containing DOACs dispensed by the hospital pharmacists were evaluated. The DOAC check sheet described indications, dosage regimens, dose reduction criteria, and contraindications for each drug and included the patient’s information. The check sheet was set to print automatically in the dispensing room at the same time as the prescription when an inpatient was prescribed DOACs. This check sheet was evaluated using a prescription survey and a questionnaire for pharmacists.ResultsThe usefulness of this check sheet for the correct use of DOACs was evaluated. There were four inquiries out of 642 (0.6%) prescriptions from pharmacists to physicians regarding DOAC prescriptions, such as the dose introduced before DOAC check sheet utilization, and there were 21 out of 905 (2.3%) prescriptions when the DOAC check sheet was used it, showing a significant increase (p = 0.0089). After the introduction of this sheet, overdoses of DOACs were identified at the time of dispensing. Of the 52 pharmacists who responded to the questionnaire, 51 (98%) stated that the check sheet was useful.ConclusionThe use of the DOAC check sheet is likely to render safety to DOAC drug therapy for individual patients.
Highlights
Renal function and use of concomitant medications should be carefully monitored in patients subjected to treatment with direct oral anticoagulants (DOACs); the dose should be individually designed for each patient
The number of inquiries from pharmacists to physicians regarding DOAC prescriptions was 4 out of 642 (0.6%) before using the DOAC check sheet and was 21 out of 905 (2.3%) after its use, showing a significant increase (p = 0.0089); the increase involved the prescription of all DOACs (Fig. 2b)
The number of DOAC prescriptions for which the dose was subjected to reduction as per the patient’s profile was four before the introduction of the DOAC check sheet and 12 after the introduction
Summary
Renal function and use of concomitant medications should be carefully monitored in patients subjected to treatment with direct oral anticoagulants (DOACs); the dose should be individually designed for each patient. DOACs are effective against various types of thrombosis [1–5] and are used for the prevention and treatment of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Rivaroxaban, apixaban, and edoxaban are effective in treating and preventing the recurrence of venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolisms (PEs). DOACs are subjected to dose reduction according to the patient profile, but unlike warfarin, it does not require frequent blood tests, such as for the prothrombin time-international normalized ratio (PT-INR). Because the blood concentration of DOACs fluctuates greatly depending on renal function and concomitant medications [2–5], the risk of bleeding increases due to their high efficacy [7]. It is very important to adjust the dose of DOAC for each patient
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