title: Appropriateness of direct oral anticoagulant dosing for venous thromboembolism treatment.
abstract: Adherence to FDA-approved dosing for the direct oral anticoagulants (DOACs) based on renal function, hepatic function, and concomitant medications in a real-world setting has not been evaluated. The purpose of this retrospective cohort analysis was to determine the prescribing accuracy of DOAC dosing for venous thromboembolism (VTE) treatment compared with enoxaparin. The secondary outcomes were to describe the incidence of in-hospital VTE recurrence and bleeding on DOAC therapy. The study included 168 patients with 261 admissions for the DOAC group and 639 patients with 841 admissions for the enoxaparin group. Dosing was appropriate in 235/261 (90.0%) of patient admissions in the DOAC group. Among the DOAC doses administered, 233/2246 (10.4%) were contraindicated based on renal function, hepatic function, or drug interactions compared with 322/7293 (4.4%) of administered enoxaparin doses evaluated based on renal function, p < 0.001. Three recurrent VTEs, 3 major bleeding events, 1 probable major bleeding event, and 3 clinically relevant non-major bleeding events were observed during the study period. Although a majority of DOAC doses administered were appropriate, further education and close monitoring of these agents are warranted to increase appropriateness of therapy and improve patient safety.
authors.affiliation: Washington State University College of Pharmacy, Yakima, WA, USA. emmeline.tran@wsu.edu.
authors.forename: Emmeline
authors.identifier: http://orcid.org/0000-0003-1062-985X
authors.initials: E
authors.lastname: Tran
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Duckett
authors.affiliation: Medical University of South Carolina College of Pharmacy, Charleston, SC, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fisher
authors.affiliation: Medical University of South Carolina College of Pharmacy, Charleston, SC, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Bohm
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D015331:Cohort Studies; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D006470:Hemorrhage; D006801:Humans; D007668:Kidney / Q000502:physiology; D008099:Liver / Q000502:physiology; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin
keywords: Direct oral anticoagulants; Dosing; Enoxaparin; Venous thromboembolism