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May 30, 2026Chonnam Medical JournalOpen Access

Oral anticoagulants achieve guideline-based dosing in only ~60% of apixaban and rivaroxaban users.

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Why the study?

Inappropriate use of oral anticoagulants can increase adverse effects and reduce therapeutic efficacy, prompting evaluation of their utilization patterns, dosing appropriateness, and adverse effects in a tertiary hospital.

Population

1,027 patients aged ≥18 years receiving warfarin, rivaroxaban, or apixaban in Iran

Comparison

Warfarin vs rivaroxaban vs apixaban

Design

Retrospective cross-sectional study

Key result

Among patients receiving oral anticoagulants, adverse effects occurred in 12.1% of patients, and guideline-based dosing was achieved in only 61.9% of apixaban and 58.6% of rivaroxaban users.

Authors

SJShima JafariSFSara FarooghiMMMandana Moradi

Discussion

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Overview

Suboptimal dosing adherence warrants clinician review; leaves open whether interventions enhance outcomes in larger cohorts.

Key Points

  • To evaluate the utilization patterns and adverse effects of oral anticoagulants in a hospital setting.
  • Retrospective cross-sectional study conducted from April 2020 to September 2022
  • Data collected from medical records and pharmacy databases for patients receiving warfarin, rivaroxaban, or apixaban
  • Dosing appropriateness assessed using EHRA and UpToDate guidelines, and adverse effects classified according to ACC criteria.
  • Among 1,027 patients, rivaroxaban was most prescribed (43.5%), followed by warfarin (33.2%) and apixaban (23.3%)
  • Adverse effects occurred in 12.1% of patients, mainly minor bleeding, primarily associated with warfarin
  • Guideline adherence for dosing was 61.9% for apixaban, 58.6% for rivaroxaban, and 46.9% for warfarin.

Study Design

Type

Cross-Sectional (n=1,027)

Multicenter

No

Structured PICO

P
Population
1,027 patients aged ≥18 years receiving warfarin, rivaroxaban, or apixaban, mean age 64±16.4 years, 52.3% male, at a tertiary hospital in Iran.
I
Intervention
Oral anticoagulants (warfarin, rivaroxaban, apixaban)
O
Outcome
Utilization patterns, dosing appropriateness, and adverse effectssafety

Guideline adherence for oral anticoagulant dosing was suboptimal, highlighting the need for improved prescriber education and routine renal monitoring.

Limitations

  • Retrospective cross-sectional design relying on medical record review, which may have introduced documentation bias
  • Conducted at a single tertiary care hospital, restricting generalizability
  • Lack of pre-hospital admission information regarding anticoagulant therapy

Cite This Study

Jafari et al. (2026) conducted a cross-sectional in Thromboembolic disorders (n=1,027). Oral anticoagulants (rivaroxaban, warfarin, apixaban) was evaluated on Adverse effects occurrence. Among patients receiving oral anticoagulants, adverse effects occurred in 12.1% of patients, and guideline-based dosing was achieved in only 61.9% of apixaban and 58.6% of rivaroxaban users.

synapsesocial.com/papers/6a1a80550307b7850943244chttps://doi.org/10.4068/cmj.2026.62.2.47
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Utilization and prescribing patterns of direct oral anticoagulants2017 · 67 citations
  2. 2Dosing Accuracy of Direct Oral Anticoagulants in an Academic Medical Center2017 · 11 citations
  3. 3Inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation2016 · 24 citations
  4. 4Pharmacist Interventions Regarding the Appropriateness of Apixaban, Rivaroxaban, Dabigatran, and Warfarin in a University-Affiliated Outpatient Clinic2016 · 12 citations
  5. 55PSQ-064 Analysis of pharmaceutical interventions on direct acting oral anticoagulants in a tertiary care hospital2024