Direct oral anticoagulants in real clinical practice: analysis of patient characteristics and prescribing patterns in a large teaching hospital

摘要

Direct oral anticoagulants (DOACs) became rapidly accepted as an alternative to warfarin in the prevention of stroke in atrial fibrillation and prophylaxis of thromboembolic events. Their safety and efficacy have been well documented in several studies, however, as with any new drug, use in real-world population often reveals risk factors that may affect treatment outcomes. The aim of the study was to determine the prescribing patterns and analyse patient characteristics to identify incidence of selected factors (age, weight, comorbidities and interacting medication) that may affect DOAC safety and efficacy. We conducted a 12-months retrospective study of 504 patients who were initiated DOAC in a large university hospital. Basic demographics, indication for DOAC prescribing, renal functions, co-medication, comorbidities and prescribing service were collected from the hospital's electronic records. Rivaroxaban accounted for the majority of DOAC prescriptions (58.9%), and prophylaxis of deep venous thromboembolism was the main reason for initiation of DOACs (58.7%). We found significant variability in terms of age (16-96 years) and weight (34.5-184 kg). Chronic renal failure was present in 5.6% of patients. We identified 101 clinically relevant drug interactions of DOACs, mostly with selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (31.7%) and nonsteroidal anti-inflammatory drugs (28.7%). Only three drug interactions were rated as contraindicated. Hypertension (48.6%), dyslipidaemia (33.1%), musculoskeletal disorders (21.0%) and diabetes mellitus (16.1%) were the most frequent comorbidities. Clinicians should be careful when prescribing DOACs to patients with comorbidities or co-medication that have the potential to increase risk of bleeding or decrease anticoagulant activity of DOACs.