title: New oral anticoagulants: appropriateness of prescribing in real-world setting.
abstract: BACKGROUND
  The new oral anticoagulants (NOAC) have been extensively studied in the clinical trial setting; however, concerns remain about the safety of prescribing in the elderly and patients with renal impairment.
  
  
  OBJECTIVE
  The aim of this study was to assess the appropriateness of NOAC prescribing in a real-world setting in terms of patient selection and to compare patient demographics to those included in pivotal clinical trials.
  
  
  METHODS
  One hundred and seventy-six patients from three tertiary university teaching hospitals were identified over 3 months in 2014.
  
  
  RESULTS
  Median age of the cohort was 74 years (interquartile range: 61-81 years), with a range of 23-96 years. Overall, 34% of the study population were prescribed a NOAC inappropriately. Of these, treatment was contraindicated in 40%, predominantly due to severe renal impairment, 22% were prescribed an excessively high dose, while 38% were under dosed. Although community-initiated patients had poorer renal function (glomerular filtration rate 91.7 ± 55.7 vs 69.3 ± 38.9, P = 0.024), appropriateness of prescription was no different compared to hospital-initiated patients (78% during admission cf. 61% prior, P = 0.061). Appropriate prescribing was better in patients with venous thromboembolism compared to AF (85% appropriate cf. 60%, P = 0.021).
  
  
  CONCLUSIONS
  Our findings imply that there remains considerable uncertainty about appropriate prescribing and dosing of NOAC, particularly in patients with impaired renal function. We recommend judicious prescribing and regular monitoring of renal function in patients at high risk of complications from NOAC therapy.
authors.affiliation: Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: C S
authors.initials: CS
authors.lastname: Pattullo
authors.affiliation: Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Barras
authors.affiliation: Pharmacy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Tai
authors.affiliation: Department of General and Acute Care Medicine, Ipswich Hospital, Brisbane, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: McKean
authors.affiliation: Department of Clinical Pharmacology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Donovan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001315:Australia; D000075202:Contraindications; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications*; D054556:Venous Thromboembolism / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: NOAC; anticoagulants; elderly; prescribing; renal function