title: Appropriateness of prescribing dabigatran etexilate and rivaroxaban in patients with nonvalvular atrial fibrillation: a prospective study.
abstract: BACKGROUND
  Direct oral anticoagulants have been developed to address some of the drawbacks of vitamin-K antagonists. However, special attention should be given when using these drugs, especially in patients with renal insufficiency, questionable compliance, and those at high risk of bleeding.
  
  
  OBJECTIVE
  To evaluate the appropriateness of prescribing dabigatran etexilate (DE) and rivaroxaban in patients with nonvalvular atrial fibrillation (NVAF) in real-life clinical practice.
  
  
  METHODS
  This was a prospective study that included patients presenting to a teaching hospital from April to mid-October 2013, who were taking rivaroxaban or DE for NVAF. Appropriateness of prescribing was evaluated using 9 of the 10 criteria of the Medication Appropriateness Index. The primary outcome measure was the prevalence of inappropriate prescribing. Secondary outcome measures included (a) categories of inappropriateness, (b) prevalence of adverse drug events, and (c) interventions made by a clinical pharmacist to optimize prescribing.
  
  
  RESULTS
  A total of 69 patients were evaluated; 16 patients (23%) had 1 inappropriate criterion, and an additional 18 (26%) had more than 1 inappropriate criterion. The most frequent inappropriate criteria were inappropriate choice (28% of patients), wrong dosage (26%), and impractical modalities of administration (26%). An adverse event (AE) was found in 51% of patients (including 8 patients with transient ischemic attack/stroke). The clinical pharmacists performed 48 interventions, and 94% were accepted by the physician.
  
  
  CONCLUSIONS
  Inappropriate use of DE and rivaroxaban in patients with NVAF is frequent and possibly leads to AEs. Reinforcing education of health care professionals and patients is needed. Collaboration with clinical pharmacists can contribute to better use.
authors: CHU Dinant-Godinne UCL Namur, Yvoir, Belgium Namur Thrombosis and Haemostasis Center (NTHC), Namur, Belgium.
authors: Anne-Sophie
authors: AS
authors: Larock
authors: CHU Dinant-Godinne UCL Namur, Yvoir, Belgium Namur Thrombosis and Haemostasis Center (NTHC), Namur, Belgium Department of Pharmacy, University of Namur, Belgium.
authors: François
authors: F
authors: Mullier
authors: CHU Dinant-Godinne UCL Namur, Yvoir, Belgium Namur Thrombosis and Haemostasis Center (NTHC), Namur, Belgium.
authors: Anne-Laure
authors: AL
authors: Sennesael
authors: Namur Thrombosis and Haemostasis Center (NTHC), Namur, Belgium Department of Pharmacy, University of Namur, Belgium.
authors: Jonathan
authors: J
authors: Douxfils
authors: CHU Dinant-Godinne UCL Namur, Yvoir, Belgium Namur Thrombosis and Haemostasis Center (NTHC), Namur, Belgium.
authors: Bérangère
authors: B
authors: Devalet
authors: CHU Dinant-Godinne UCL Namur, Yvoir, Belgium Namur Thrombosis and Haemostasis Center (NTHC), Namur, Belgium.
authors: Christian
authors: C
authors: Chatelain
authors: Namur Thrombosis and Haemostasis Center (NTHC), Namur, Belgium Department of Pharmacy, University of Namur, Belgium.
authors: Jean-Michel
authors: JM
authors: Dogné
authors: CHU Dinant-Godinne UCL Namur, Yvoir, Belgium Namur Thrombosis and Haemostasis Center (NTHC), Namur, Belgium Université Catholique de Louvain (UCL), Louvain Drug Research Institute (LDRI), Brussels, Belgium anne.spinewine@uclouvain.be.
authors: Anne
authors: A
authors: Spinewine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000009:adverse effects*; D000069604:Dabigatran; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000009:adverse effects*; D011446:Prospective Studies; D011725:Pyridines / Q000009:adverse effects*; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011725:Pyridines; D013876:Thiophenes; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: dabigatran etexilate; drug-related side effects and adverse reactions; medication errors; rivaroxaban; atrial fibrillation