Key result
Pharmacist-led DOAC optimization yields substantial cost savings with unchanged bleeding rates.
Why the study?
The increasing use of direct oral anticoagulants poses challenges related to prescribing appropriateness and clinical safety in primary care.
Does a primary care pharmacist-led individualized pharmacotherapeutic review improve the appropriateness of DOAC prescribing, reduce costs, and maintain safety in real-world clinical practice?
Observational (n=791)
Yes
Does a primary care pharmacist-led individualized pharmacotherapeutic review improve the appropriateness of DOAC prescribing, reduce costs, and maintain safety in real-world clinical practice?
Relative Risk: 0.99
Absolute Event Rate: 5.24% vs 5.3%
p-value: p=1.000
A pharmacist-led pharmacotherapeutic review in primary care optimized DOAC prescribing by safely increasing dabigatran use, yielding substantial healthcare cost savings without compromising clinical safety.
Pharmacist-led DOAC optimization may generate savings with stable bleeding in primary care; leaves open need for randomized confirmation before broader adoption.
Introduction Direct oral anticoagulants are among the first-line treatments for stroke prevention in patients with non-valvular atrial fibrillation and for the treatment and secondary prevention of venous thromboembolism. The increasing use of these agents poses challenges related to prescribing appropriateness, clinical safety. This study aims to evaluate the impact of a primary care pharmacist-led intervention on the appropriateness of DOAC prescribing, pharmacotherapeutic efficiency, and clinical outcomes. Materials and Methods A retrospective, quasi-experimental before-and-after study was conducted in the healthcare area of Xarxa Santa Tecla (Tarragonès and Baix Penedès, Spain). 791 patients receiving DOAC therapy were included. The intervention comprised multidisciplinary educational activities, individualized pharmacotherapeutic review, and communication of recommendations to prescribers. Results The mean age was 78.2 years, and 43.2% of patients had moderate or severe renal impairment. The pharmacotherapeutic review identified 527 patients (66.6%) as candidates for treatment optimization, through a proposed switch from apixaban to dabigatran. The pharmacist intervention was associated with changes in prescribing patterns among newly initiated patients, increasing the use of dabigatran. The economic analysis estimated savings of €75,508.81 from new treatment initiations and €31,288.25 from therapeutic switches, resulting in total savings of €106,797.06 in 2025. The overall bleeding rate remained stable (5.3% in 2024% vs. 5.2% in 2025), with no deterioration in clinical safety. In conclusion, a structured, multidisciplinary, and coordinated primary care pharmacist-led intervention promoted a more efficient use of healthcare resources, while no deterioration in population-level safety indicators was observed. These findings reinforce the role of primary care pharmacists in optimizing anticoagulant therapy.
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Guzmán et al. (2026) conducted an observational in Non-valvular atrial fibrillation and venous thromboembolism requiring DOAC therapy (n=791). Primary care pharmacist-led pharmacotherapeutic review vs. Pre-intervention routine clinical practice was evaluated on Overall bleeding rate (RR 0.99, p=1.000). A primary care pharmacist-led DOAC optimization intervention generated €106,797 in estimated annual savings, while the overall bleeding rate remained stable (5.2% vs 5.3%).
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