Publication:
Prescriber compliance to direct oral anticoagulant labels and impact on outcomes in Thailand

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Issued Date

2021

Resource Type

Article

Language

eng

File Type

application/pdf

ISSN

3065251

DOI

10.1111/bcp.14535

Other identifier(s)

2-s2.0-85090448785

Rights Holder(s)

Scopus

Bibliographic Citation

British Journal of Clinical Pharmacology. Vol 87, No.3 (2021), p.1390-1400

Suggested Citation

Wattanaruengchai P., Nathisuwan S., Rattanavipanon W., Chulavatnatol S., Kongwatcharapong J., Mitsuntisuk P., Chaiyasothi T., Kritsanapipat D., Phrommintikul A., Chaiyakunapruk N., Likittanasombat K., Lip G.Y.H. Prescriber compliance to direct oral anticoagulant labels and impact on outcomes in Thailand. British Journal of Clinical Pharmacology. Vol 87, No.3 (2021), p.1390-1400. doi:10.1111/bcp.14535 Retrieved from: https://hdl.handle.net/20.500.14740/7872

Title

Prescriber compliance to direct oral anticoagulant labels and impact on outcomes in Thailand

Author(s)

Wattanaruengchai P.
 Nathisuwan S.
 Rattanavipanon W.
 Chulavatnatol S.
 Kongwatcharapong J.
 Mitsuntisuk P.
 Chaiyasothi T.
 Kritsanapipat D.
 Phrommintikul A.
 Chaiyakunapruk N.
 Likittanasombat K.
 Lip G.Y.H.

Abstract

Aims: This study aimed to evaluate the prescriber compliance to the approved labels of direct oral anticoagulants (DOACs) and impact of appropriateness of dosing on clinical outcomes. Methods: A retrospective study was conducted using simple-stratified random sampling of adult patients receiving ≥6 months of DOACs for various indications during 2013–2017 in 10 tertiary care hospitals. Patients were classified into 3 dosing groups including approved dose, underdosing and overdosing based on the Thai Food and Drug Administration-approved labels. Cox proportional hazard models were used to evaluate the impact of different dosings on thromboembolic and bleeding events. Results: From 1200 patients included in the data analysis, prescribing of DOACs was consistent with the approved indications in 1130 cases (94.2%) while 70 patients (5.8%) received DOACs despite having contraindications or with off-label usage. Among 1026 cases of dosing evaluation cohort, 688 patients (67.1%) received approved doses. There were 227 (21.9%) and 110 (10.7%) cases of underdosing and overdosing, respectively. Multivariate analysis showed that underdosing was associated with an increased risk of thromboembolism 3.023 (95% confidence interval [CI]: 1.291–7.080; P =.011) while overdosing was associated with an increased risk of bleeding requiring hospitalization (adjusted hazard ratio, 3.045; 95% CI, 1.501–6.178; P =.002) and Bleeding Academic Research Consortium type 2 or more (adjusted hazard ratio, 2.196; 95% CI, 1.083–4.452; P =.029). Conclusion: Prescribers’ compliance to approved indications were high. However, 1/3 of DOAC prescriptions were inconsistent with approved dosing. Dosing deviation was associated with an increase in adverse clinical outcomes. © 2020 The British Pharmacological Society

Subject(s)

Antithrombocytic agent
 Apixaban
 Beta adrenergic receptor blocking agent
 Dabigatran
 Dipeptidyl carboxypeptidase inhibitor
 Hydroxymethylglutaryl coenzyme A reductase inhibitor
 Rivaroxaban
 Warfarin
 Anticoagulant agent
 Aged
 Article
 Atrial fibrillation
 Cerebrovascular accident
 Clinical outcome
 Cohort analysis
 Controlled study
 Deep vein thrombosis
 Embolism
 Female
 Follow up
 Food and Drug Administration
 Human
 Human tissue
 Lung embolism
 Major clinical study
 Male
 Medication compliance
 Multicenter study (topic)
 Patient compliance
 Prescription
 Priority journal
 Retrospective study
 Tertiary care center
 Thailand
 Thromboembolism
 University hospital
 Adult
 Atrial fibrillation
 Oral drug administration
 Administration, Oral
 Adult
 Anticoagulants
 Atrial Fibrillation
 Humans
 Retrospective Studies
 Thailand

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URI

https://hdl.handle.net/20.500.14740/7872

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Scopus: Year 1983-2021

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