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Background The predictors of clinically significant bleeding events (CSBEs) associated with direct oral anticoagulants (DOACs) are poorly characterised in literature. Aim To determine the incidence and predictors of CSBEs in patients receiving DOACs. Methods Patients who received DOACs during admission under a general medical unit over a two-year period were retrospectively studied. Following index admission, patients were followed for 12 months or for the duration of treatment (if the latter was less than 12 months). The relevant data were obtained by review of medical records. Results A total of 203 patients were studied over a mean follow-up period of 293 (±81) days. The incidence of CSBE was 13.7 (95%CI 9.5-21.1) per 100 person-years. Age ≥ 75 years (P=0.01), concurrent use of antiplatelet medications (P=0.02) and lower estimated creatinine clearance (CrCl) (P=0.03) had a significant univariate association with CSBEs. However, in the multivariate logistic regression only concurrent use of antiplatelet medications remained significantly associated with CSBEs (adjusted OR3.6, 95%CI:1.4-9.6, P=0.01). Concurrent use of antiplatelet medications was also independently associated with major bleeding events (MBEs) (adjusted OR4.9, 95%CI:1.1-21.4, P=0.04). Although 39 (19.2%) patients received antiplatelet medications, the indications for concurrent antiplatelet use complied with current guidelines in only 3 (7.7%) patients. Conclusion Caution should be exercised when prescribing antiplatelet medications with DOACs, as this combination is a potential risk factor for both major and non-major clinically significant bleeding events. In most patients, the concurrent use of antiplatelet medications was discordant with the current consensus guidelines. This article is protected by copyright. All rights reserved.

Background Smoking cessation intervention is a key component in the management of chronic obstructive pulmonary disease (COPD). Aims To evaluate the prescribing of smoking cessation therapies (SCT) among hospital clinicians and identify factors that may hinder delivery of effective interventions. Methods A retrospective analysis of medical records of patients admitted to the Royal Hobart Hospital with an acute exacerbation of COPD was performed. A survey of hospital clinicians was also performed to ascertain levels of training and confidence in prescribing SCT. Results Nearly all medical and non-medical hospital clinicians self-reported confidence in offering SCT (91.1 vs 82.5%, respectively, P = 0.216). However, of the 122 eligible patients in our study population, the majority did not have any form of SCT initiated during their admission (n = 68, 55.7%) and only 21 patients (17.2%) were referred to the nurse-led smoking cessation service. Very few patients were initiated on efficacious regimes such as combination-nicotine replacement therapy (n = 8, 6.6%) or varenicline (n = 2, 1.6%). Only a small proportion of hospital doctors reported confidence in prescribing varenicline and bupropion (17.2 and 6.9%, respectively). Furthermore, very few hospital doctors reported ever receiving formal training in SCT compared to non-medical hospital staff (42.2 vs 84.5%, P Conclusion Our study highlights the real-life challenges in tackling nicotine dependence in hospitals: under-utilisation of evidence-based pharmacotherapies, limited access to formal training for doctors and poor uptake of nurse-led smoking cessation services. Granting limited prescribing rights for specialised nurses may help hospital clinicians to alleviate gaps in current clinical practice.