Hospital drug utilization review of dabigatran and rivaroxaban in France

Abstract

Summary Introduction We conducted a Hospital drug utilization review (HDUR) of dabigatran and rivaroxaban in a French teaching hospital. This evaluation enhances the quality of care as well as the appropriate use of both these drugs. Patients and methods A retrospective, monocentric study, spanning a period of 14 months, dealing with an analysis of the medical files of 48 patients aged 30 to 84 years, was conducted in a department of orthopedic surgery. These patients, who had undergone elective hip or knee replacement surgery, were split into four groups depending on the oral thromboprophylaxy they received. The following aspects were taken into account: usual patient information; clinical data, such as factors increasing the risk of venous thromboembolism events (VTE); mechanical means of preventing thrombosis; and criteria evaluating VTE, bleeding risk, and the effective use of anticoagulants. Results are expressed as median (quartile 1–3) and analyzed with non parametric tests for P values Results and conclusion Our Hospital drug utilization review of dabigatran and rivaroxaban confirms the major interest in these oral anticoagulants. Our study clarified, to some extent, the profile of our patients, laid down detailed rules for their use, and tracked their adverse reactions. Our results are adequate proof that the monitoring conducted by clinical pharmacists in France is accurate: dabigatran and rivaroxaban therapy respected the appropriate use of referentials. This study considerably improved the communication between French clinical pharmacists and medical staff and also had a substantive impact on the control of the expenses. The practitioners of our hospital prescribed rivaroxaban to patients with a history of VTE and low doses of dabigatran to patients older than 75 years, those treated by amiodarone, and those exhibiting moderate renal insufficiency. However, for the prevention of postoperative thromboembolic events, injectable anticoagulants were not overridden by these two oral anticoagulants.