Open AccessPB2443 AUDIT ON NOACS (APIXABAN AND RIVAROXABAN) PRESCRIPTION IN A DISTRICT GENERAL HOSPITAL
Author(s) -
Lovato S.,
Kanakam T.,
Vajia P.,
Dosanjh J.,
Harford D.
Publication year - 2019
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/01.hs9.0000568232.16539.8b
Subject(s) - apixaban , rivaroxaban , medicine , vitamin k antagonist , atrial fibrillation , stroke (engine) , warfarin , mechanical engineering , engineering
Background: Oral anticoagulation therapy is the treatment of choice to prevent stroke in patients with non valvular atrial fibrillation. Non‐vitamin K antagonist oral anticoagulants (NOACs) are often used as alternative to vitamin K antagonists as they do not require INR level monitoring. Before initiating the anticoagulant therapy the risk of stroke should be evaluated using the CHA2DS2‐VASc score and the bleeding risk using the HAS‐BLED score. In our institution the most used NOACs are Apixaban and Rivaroxaban. The recommended dose for Apixaban is 5 mg bd, reduced to 2.5 mg twice bd in patients with age >80, weight < 61 kg or serum creatinine > 133 micromol/litre. The recommended dose for Rivaroxaban is 20 mg od. Aims: The aim of this study was to understand the appropriateness of NOACs use in our institution in terms of indication and dose compared to the national guidelines. Methods: We performed an audit including all new patients who attended our anticoagulation service in a period of six months and were started on either Apixaban or Rivaroxaban. To do this we evaluated if the indication for anticoagulation was appropriate, if CHA2DS2‐VASc score HAS‐BLED score were documented on the notes. We also evaluated the appropriateness of the dose adjusted for creatinine of Apixaban. Results: We included 57 patients, 29 of them were started on Apixaban and 28 on Rivaroxaban. All of the patients had a diagnosis of Non Valvular Atrial Fibrillation. CHA2DS2‐VASc score was documented in 31 patients (54%) and HAS‐BLED score in 32 patients (56%), only 22 patients (38%) had both score properly documented. Out of 31 patients 4 (13%) had a CHA2DS2‐VASc score of 0, and out of 32 patients 2 (6%) had a HAS‐BLED score >3. This mean that in 19% of the patients the anticoagulation therapy was not indicated or contraindicated, but also that in 62% of the patients the appropriateness could not be properly evaluated. Creatinine was documented only in 11 of the patients on Apixaban (38%), in all of them the dose was appropriate for renal function. Summary/Conclusion: We included 57 patients, 29 of them were started on Apixaban and 28 on Rivaroxaban. All of the patients had a diagnosis of Non Valvular Atrial Fibrillation. CHA2DS2‐VASc score was documented in 31 patients (54%) and HAS‐BLED score in 32 patients (56%), only 22 patients (38%) had both score properly documented. Out of 31 patients 4 (13%) had a CHA2DS2‐VASc score of 0, and out of 32 patients 2 (6%) had a HAS‐BLED score >3. This mean that in 19% of the patients the anticoagulation therapy was not indicated or contraindicated, but also that in 62% of the patients the appropriateness could not be properly evaluated. Creatinine was documented only in 11 of the patients on Apixaban (38%), in all of them the dose was appropriate for renal function.