Why the study?
Is dabigatran prescribing associated with higher rates of inappropriate indication and dosing compared to rivaroxaban in real-world practice?
Is dabigatran prescribing associated with higher rates of inappropriate indication and dosing compared to rivaroxaban in real-world practice?
In real-world practice in Qatar, DOACs are frequently prescribed inappropriately, with dabigatran and poor renal function being significant risk factors for inappropriate dosing.
Inappropriate DOAC dosing common in inpatients; leaves open whether stewardship programs improve appropriateness in routine care.
INTRODUCTION: Over the past few years, direct oral anticoagulants (DOACs) have been gradually replacing warfarin. Inappropriate prescribing of DOACs in real-life practice settings can affect their perceived safety and efficacy, especially with the lack of a surrogate marker for guidance. OBJECTIVES: To describe the appropriateness of DOACs prescribing, compare dabigatran to rivaroxaban in terms of inappropriate prescribing, and determine other factors associated with inappropriate DOACs use. METHODS: In this cross-sectional retrospective study, 5-year DOAC prescriptions data were extracted. Appropriateness was evaluated based on approved dosing and indications in Canada and the United States. Descriptive and inferential statistics were performed using SPSS. RESULTS: From 2011 to 2015, there were 1049 DOACs prescriptions, among which 572 (54.5%) were for dabigatran and 477(45.5%) were for rivaroxaban. The DOACs were prescribed for inappropriate indication in 35 (3.3%) patients, while inappropriate dosing was found in 352 (33.6%) prescriptions. There were significantly more inappropriate dabigatran prescriptions compared to rivaroxaban both in terms of indication (4.7% vs 1.7%, P = .004) and dosing (50.9% vs 12.8%, P < .001). Logistic regression analysis confirmed that dabigatran prescribing was the only factor associated with inappropriate indications (odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.3-6.5). Factors associated with inappropriate dosing included dabigatran prescriptions (OR = 7.6, 95% CI: 5.5-10.5) and poor renal function (OR = 14.6, 95% CI: 3.6-58.4). CONCLUSION: Direct oral anticoagulants have been gradually replacing warfarin in Qatar; however, they are not always prescribed appropriately especially in patients on dabigatran and those with renal impairment. Educating health-care practitioners is necessary. Future studies comparing the clinical safety and effectiveness of the DOACs especially when used at an inappropriate dose are also warranted.
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Elewa et al. (2017) studied this question.
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