4CPS-017 Misuse of novel oral anticoagulants in hospital settings

Background In the past few years, the development of three novel oral anticoagulants (NOACs), which directly target thrombin or factor Xa, has brought a remarkable change in the clinical practice of anticoagulation therapy. Although they constitute an attractive alternative option to warfarin and heparin, the appropriate use of these agents is essential in order to maximise their effect and avoid adverse events. Purpose The aim of the present study is to investigate two clinical pharmacists’ interventions regarding NOACs’ usage in a private hospital. Material and methods A prospective study was conducted at a Private General Hospital from 1 January 2016 to 31 December 2016. NOACs were administered in different doses according to indication, bodyweight, age and comorbidities. During the study period, the clinical pharmacists documented all cases where NOACs were prescribed. Data were analysed so as to reveal potential medication errors. Results Totally, 370 cases of NOACs’ administration were recorded, of which, 42 (11.4%) included a medication error. Among these mistakes, 28 (66.7%) were related to erroneously calculated NOACs’ dosage based on renal function, eight (19%) to drug-drug interactions and six (14.3%) to concurrent active cancer. Apixaban was the most frequent NOAC to be erroneously administered (13 of 76 cases, 17.1%), followed by rivaroxaban (28 of 257 cases, 10.9%) and dabigatran (one of 37 cases. 2.7%). Conclusion No matter how advantageous NOACs seem to be, they are accompanied by several risks which are more likely to happen if these agents are not appropriately used. Both the efficacy and bleeding risk depend on patient variables, such as renal function, age, weight and concomitant medication, whereas, due to their recent authorisation, there is insufficient experience on their benefit-to-risk ratio in special cases, such as cancer, obesity or childhood. The present study showed that, in our hospital, a significant amount of patients (11.4%) received NOACs in a way that contradicts the product label guidelines. The necessity to take patients’ medical history and NOACs’ pharmacological characteristics into account was highlighted, along with the potential contribution of a drug-handling expert, such as a clinical pharmacist. No conflict of interest