title: Evaluation of pharmacist-managed dabigatran in an inpatient setting.
abstract: BACKGROUND
  Although therapeutic drug monitoring is not required for patients receiving dabigatran to determine therapeutic efficacy, there are a number of other factors to consider. Currently, there are no studies evaluating pharmacist-led management of dabigatran.
  
  
  OBJECTIVE
  The role of inpatient pharmacists related to the management of dabigatran was evaluated.
  
  
  METHODS
  All adult patients who received at least 1 dose of dabigatran with a length of stay greater than 24 hours in a single-center, community hospital between May 2011 and August 2012 were retrospectively reviewed (n = 176).
  
  
  RESULTS
  Almost half of the patients (46%) required pharmacist intervention related to dabigatran management during hospital admission. Of patients receiving dabigatran prior to hospital admission, 18.4% were admitted on an inappropriate home dose. Transitioning between dabigatran and alternative anticoagulants accounted for the majority of pharmacist interventions (74.2%), with patients transitioning from unfractionated heparin to dabigatran occurring most frequently. Renal impairment requiring dose adjustment or drug discontinuation occurred in 6.3% of patients, whereas 6.8% of patients required pharmacist intervention for procedural anticoagulation. Inpatient therapy was determined to be relatively safe, with few patients (1.7%) requiring permanent discontinuation of dabigatran as a result of a bleeding complication.
  
  
  CONCLUSIONS
  Pharmacists significantly contributed to the safe and appropriate use of dabigatran during hospitalization.
authors.affiliation: St John Hospital and Medical Center, Detroit, MI, USA.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Tedders
authors.forename: Michael F
authors.initials: MF
authors.lastname: Lucey
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Edwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D000069604:Dabigatran; D016903:Drug Monitoring; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran
keywords: anticoagulation; dabigatran; intervention; pharmacist