title: Dabigatran Use in the Real World: A Multihospital System Experience.
abstract: Dabigatran etexilate, an oral direct thrombin inhibitor, was approved by the Food and Drug Administration to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation based on the outcomes of the Randomized Evaluation of Long-term anticoagulant therapY (RE-LY) study. Although this study provides robust data on the efficacy and safety of dabigatran, there may be differences in the drug use and outcomes in routine clinical practice following drug approval. In this retrospective chart review study, we describe the use of dabigatran in 160 patients in 4 adult hospitals (1 academic and 3 community), including appropriate prescribing for indication, starting dose, concomitant anticoagulant and antiplatelet use, and clinical outcomes such as bleeding, myocardial infarction, and stroke. The study revealed appropriate indication of nonvalvular atrial fibrillation in 145 (91%) of the 160 patients. The dose of dabigatran was appropriate in 90% of the patients, with the most common cause of inappropriate dosing due to perceived bleeding risk. Over a follow-up period of 6 months, bleeding complications were noted in 6 patients still taking dabigatran, 5 of which were gastrointestinal bleeding. Our study underscores the importance of prescriber education regarding the appropriate indication, dosage, and safety of dabigatran with active participation of pharmacists in this process.
authors: Department of Pharmacy, Methodist Healthcare-University Hospital, Memphis, TN, USA lauren.kimmons@mlh.org.
authors: Lauren A
authors: LA
authors: Kimmons
authors: Department of Internal Medicine, Division of Cardiology, University of Tennessee Health Science Center-School of Medicine, Memphis, TN, USA.
authors: Rajesh
authors: R
authors: Kabra
authors: Department of Pharmacy, Methodist Healthcare-University Hospital, Memphis, TN, USA.
authors: McLisa
authors: M
authors: Davis
authors: Department of Pharmacy, Methodist Healthcare-University Hospital, Memphis, TN, USA.
authors: Beth V
authors: BV
authors: Segars
authors: Department of Pharmacy, Methodist Healthcare-University Hospital, Memphis, TN, USA.
authors: Carrie S
authors: CS
authors: Oliphant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000069604:Dabigatran / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D010975:Platelet Aggregation Inhibitors; D000069604:Dabigatran
keywords: clinical practice; dabigatran; pradaxa; prescribing