Abstract
PurposeThis study aimed to estimate the prevalence, contributory factors, and severity of medication errors associated with direct acting oral anticoagulants (DOACs).MethodsA systematic review and meta-analysis were undertaken by searching 11 databases including Medline, Embase, and CINHAL between January 2008 and September 2020. The pooled prevalence of errors and predictive intervals were estimated using random-effects models using Stata software. Data related to error causation were synthesised according to Reason’s accident causation model.ResultsFrom the 5205 titles screened, 32 studies were included which were mostly based in hospitals and included DOAC treatment for thromboembolism and atrial fibrillation. The proportion of study population who experienced either prescription, administration, or dispensing error ranged from 5.3 to 37.3%. The pooled percentage of patients experiencing prescribing error was 20% (95% CI 15–25%; I2 = 96%; 95% PrI 4–43%). Prescribing error constituted the majority of all error types with a pooled estimate of 78% (95%CI 73–82%; I2 = 0) of all errors. The common reported causes were active failures including wrong drug, and dose for the indication. Mistakes such as non-consideration of renal function, and error-provoking conditions such as lack of knowledge were common contributing factors. Adverse events such as potentially fatal intracranial haemorrhage or patient deaths were linked to the errors but causality assessments were often missing.ConclusionsDespite their favourable safety profile, DOAC medication errors are common. There is a need to promote multidisciplinary working, guideline-adherence, training, and education of healthcare professionals, and the use of theory-based and technology-facilitated interventions to minimise errors and maximise the benefits of DOACs usage in all settings.ProtocolA protocol developed as per PRISMA-P guideline is registered under PROSPERO ID = CRD42019122996
Highlights
Direct-acting non-vitamin K antagonist oral anticoagulants (DOACs) including direct thrombin-inhibitor dabigatran, and two-factor Xa inhibitors rivaroxaban and apixaban have become the preferred choice in clinical practice for the primary and secondary stroke prevention in patients with atrial fibrillation, prevention and treatment of venous thromboembolism (VTE), and thromboprophylaxis in patients undergoing total hip or knee arthroplasty
While the relative ease of prescribing DOACs compared to Vitamin-K antagonists (VKA) makes them more commonly prescribed, healthcare professionals need to be aware of unwanted treatment outcomes associated with medication errors and suboptimal prescribing [1]
This study reports that out of 25 total prescribing errors associated with DOACs, only 2 (8%, 95% confidence interval (CI) = 0–18.6%) were identified as dispensing errors [45]
Summary
Direct-acting non-vitamin K antagonist oral anticoagulants (DOACs) including direct thrombin-inhibitor dabigatran, and two-factor Xa inhibitors rivaroxaban and apixaban have become the preferred choice in clinical practice for the primary and secondary stroke prevention in patients with atrial fibrillation, prevention and treatment of venous thromboembolism (VTE), and thromboprophylaxis in patients undergoing total hip or knee arthroplasty. Anticoagulation therapy can be given for a short term (up to around three months) or long term. Short-term anticoagulation therapy is most commonly indicated for primary perioperative prophylaxis of thromboembolic events such as those undergoing hip or knee replacement surgery. While the relative ease of prescribing DOACs compared to VKAs makes them more commonly prescribed, healthcare professionals need to be aware of unwanted treatment outcomes associated with medication errors and suboptimal prescribing [1]. Pharmacokinetic profiles and drug interactions are not fully understood
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