Journal Logo

AUDIT ON NOACS (APIXABAN AND RIVAROXABAN) PRESCRIPTION IN A DISTRICT GENERAL HOSPITAL

PB2443

Lovato, S.1; Kanakam, T.2; Vajia, P.3; Dosanjh, J.4; Harford, D.4

doi: 10.1097/01.HS9.0000568232.16539.8b
Publication Only: Thrombosis and vascular biology - Biology & translational research
Free

1Postgraduate/Haematology, London North West University Healtcare Trust, London

2The University Of Bukingham, Buckinghaml

3The University Of Bukingham, Buckingham

4Heamatology, London North West University Healtcare Trust, London, United Kingdom

Back to Top | Article Outline

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.

Back to Top | Article Outline

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.

Back to Top | Article Outline

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.

Back to Top | Article Outline

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.

Back to Top | Article Outline

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.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.