Guideline adherence with regard to direct acting oral anticoagulants use

Guideline adherence with regard to direct acting oral anticoagulants use OBJECTIVE To determine guideline adherence regarding prescribing direct acting oral anticoagulants (DOACs) in daily clinical practice, distinguishing clinical and outpatient cardiology and orthopaedy patients. DESIGN Observational retrospective cross-sectional study. METHODS Four guidelines for prescribing DOACs were summarized. Medical records were used to identify patients who received rivaroxaban, dabigatran or apixaban. Baseline characteristics and adherence to the guidelines regarding interactions, CHA2DS2-VASc, HAS-BLED, dosage, renal function etc. were compared between clinical and outpatient cardiology and orthopaedy groups. RESULTS 100 patients were included in all three groups. In four cases an interaction with possible clinical implications was found. Among almost half of the patients the CHA2DS2- VASc score was not registered. The HAS-BLED score was only determined for a handful of patients. Overtreatment was found in 3[%] of clinical cardiology patients and 7[%] of cardiology outpatients. Complications during VKA use prompted a switch to DOACs in only few cases. In 32[%] of orthopaedy patients and 41[%] of cardiology outpatients the renal function measurement was older than 60 days; in three cases the renal function was unknown. One patient with a prior cerebral haemorrhage received a DOAC without consent from a neurologist. 76[%] of patients in the outpatient group and 91[%] in the clinical cardiology group were prescribed the appropriate dose. A lower dose than appropriate was more common than a higher dose. CONCLUSION In general adherence to guidelines is good, but there is room for improvement. Verifying the absence of interactions, checking renal function and offering help with appropriate dosing can be performed by the hospital pharmacy. A way to improve determination and recording of CHA2DS2-VASc and HAS-BLED scores needs to be determined.