title: Medication utilization evaluation of dabigatran and rivaroxaban within a large, multi-center health system.
abstract: OBJECTIVE
  The objective of this medication utilization evaluation (MUE) was to determine the appropriateness of dabigatran and rivaroxaban while also reviewing outcomes for safety and effectiveness within a large, multi-center health system.
  
  
  METHODS
  A retrospective chart review was performed using the system's electronic medical record. A data inquiry was requested and generated for dabigatran usage from July 28, 2011 through July 28, 2012 and for rivaroxaban from March 1, 2012 to July 31, 2012 at eight health system hospitals. All patients receiving at least one dose were eligible for inclusion in the MUE.
  
  
  RESULTS
  For dabigatran, 78 of 390 unique patient encounters were analyzed (20%). All 62 rivaroxaban encounters were included in the analysis. Dabigatran was used for appropriate indications in 94% of encounters and 82% for rivaroxaban. Based on indication and renal function, 87% of dabigatran patients and 92% of rivaroxaban patients received correct dosing. For patients transitioning to or from another anticoagulant, appropriate transitions occurred in 44% of dabigatran transitions and 48% of rivaroxaban transitions. At discharge, 83% of dabigatran and 86% of rivaroxaban therapy was continued. There were no reported strokes or systemic embolism with dabigatran, but one reported deep vein thrombosis occurred during hospitalization with rivaroxaban therapy. Documented bleeds in 5% of dabigatran and 3% of rivaroxaban patients. Patient education was documented for 37% of dabigatran and 26% of rivaroxaban patients receiving therapeutic anticoagulation.
  
  
  CONCLUSIONS
  This MUE revealed the appropriate use of dabigatran and rivaroxaban therapy with few safety outcomes within a large, multi-center health system.
authors.affiliation: PGY-2 Pharmacotherapy Resident, Indiana University Health, Indianapolis, IN Butler University College of Pharmacy and Health Sciences, Indianapolis, IN aisaacs1@iuhealth.org.
authors.forename: Alex N
authors.initials: AN
authors.lastname: Isaacs
authors.affiliation: Butler University College of Pharmacy and Health Sciences, Indianapolis, IN.
authors.forename: Meagan
authors.initials: M
authors.lastname: Doolin
authors.affiliation: Butler University College of Pharmacy and Health Sciences, Indianapolis, IN.
authors.forename: Courtney
authors.initials: C
authors.lastname: Morse
authors.affiliation: Clinical Pharmacy Specialist-Internal Medicine, Indiana University Health, Indianapolis, IN.
authors.forename: Erin
authors.initials: E
authors.lastname: Shiltz
authors.affiliation: Butler University College of Pharmacy and Health Sciences, Indianapolis, IN Clinical Pharmacy Specialist-Internal Medicine, Indiana University Health, Indianapolis, IN.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Nisly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use*; D000069604:Dabigatran / Q000009:adverse effects / Q000627:therapeutic use*; D017723:Drug Utilization Review / Q000379:methods* / Q000592:standards; D057286:Electronic Health Records / Q000592:standards; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000991:Antithrombins; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban; D000069604:Dabigatran