Why national consumption of direct oral anticoagulants over the rise of COVID-19 pandemic exceeded all potential recommendations: A qualitative analysis of textual details of Russian clinical practice guidelines

Background COVID-19-associated thrombotic complications became a major problem of pandemic. Clinical practice guidelines are meant to present approaches to preventing and managing them. In our previous studies, we found that direct oral anticoagulants (DOACs) consumption and expenditure in Russia through COVID-19 pandemic was extensive, exceeding CPGs’ recommendations in 2020 and 2021, particularly in outpatient settings. Objective To analyze Russian clinical practice guidelines on the use of DOACs for COVID-19. Methods We conducted thematic content analysis of Russian guidelines using qualitative research methods. Purposive sampling allowed including all existing guidelines on the use of DOACs in COVID-19 pandemic. The sample size was limited to the results of our previous searches of the Russian guideline and bibliographic databases. We focused on indications, contraindications, dosing regimens, monitoring, and drug interactions and compared with international recommendations. Results Only one guideline advised against outpatient DOAC use for COVID-19, aligning with international standards. The guidelines lacked clarity on indications, dosing, and treatment duration. Only two of six guidelines included safety monitoring recommendations, while four provided precautions. Conclusion We conclude that the found textual problems could potentially cause the established excessive consumption of direct oral anticoagulants in outpatients with COVID-19 on the rise the pandemic.