Factors related to inappropriate edoxaban use

Abstract

What is known and objective The aim of this study was to evaluate the appropriateness and clinical outcomes of edoxaban use, and to determine the role of clinical pharmacists in improving the efficacy and safety of edoxaban use. Methods A retrospective study was performed by using an electronic medical record and anticoagulation clinical data from 600 patients who received edoxaban from 1 March 2016 to 16 July 2017 at a tertiary teaching university hospital. The appropriateness of edoxaban use was assessed using eight criteria based on drug use evaluation criteria developed by the American Society of Health‐System Pharmacists drug use evaluation guidelines, details in Korea Food and Drug Administration approval of edoxaban. Clinical outcomes were evaluated between the appropriately prescribed and inappropriately prescribed groups regarding the incidence of thrombosis and bleeding episodes. Results and discussion After excluding 86 patients due to the inability to assess renal function, 514 were eligible. Appropriate use was found in 294 patients (57.2%). The most frequent inappropriate use of edoxaban was dose adjustment (60.8%) in accordance with the dosing recommendation in patients with renal insufficiency (creatinine clearance [CrCl] of 15‐50 mL/min) and a low body weight of <60 kg. Moreover, there were three cases of edoxaban use in patients with prosthetic heart valves and moderate‐to‐severe mitral stenosis, and 15 cases of non‐valvular atrial fibrillation in patients with CrCl >95 mL/min in whom edoxaban use is not recommended. Furthermore, we found that the factors related to the appropriateness of edoxaban use were <60 kg body weight (adjusted odds ratio [OR]: 0.310; confidence interval [CI]: 0.197‐0.488) and CrCl <50 mL/min (adjusted OR: 0.629; CI: 0.404‐0.980). There were 45 events (8.75%) of any bleeding, 9 (1.8%) of stroke/transient ischaemic attack (TIA) and four events (0.8%) of deep vein thrombosis (DVT)/pulmonary embolism (PE). However, there was no difference between the appropriately prescribed group (294 patients) and inappropriately prescribed group (220 patients) in the incidence of bleeding events (27 [9.2%] vs 18 [8.2%]), stroke/TIA (7 [2.4%] vs 2 [0.9%]) and DVT/PE (2 [0.7%] vs 2 [0.9%]), respectively. What is new and conclusion Although edoxaban has a broad therapeutic window that does not require routine monitoring, it should be cautiously used in patients with renal insufficiency (CrCl <50 mL/min) and body weight <60 kg.

Effect of oral anticoagulants in atrial fibrillation patients with polypharmacy: a meta-analysis

“…By reviewing the title and abstract, 19 remaining studies were potentially available, and further assessed under the full-text screenings. According to the pre-defined inclusion and exclusion criteria, we subsequently excluded 7 studies because (1) article is a meta-analysis (n=1) [16]; (2) studies did not report the relevant outcomes (n=3) [17][18][19]; (3) studies did not report the classification of polypharmacy (n=3) [20][21][22]. Finally, a total of 12 studies were included in our meta-analysis [8-10, 15, 23-30].…”

Determinants for under‐ and overdosing of direct oral anticoagulants and physicians' implementation of clinical pharmacists' recommendations

“…[2][3][4] Several studies have shown that DOACs are frequently prescribed incorrectly with inappropriate dosing varying from 12.8 to 42.8% of AF patients as well as other patients. 3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Inappropriate prescribing has been shown to be an independent risk factor for adverse drug events leading to potential clinical consequences including thromboembolism, bleeding, hospitalization and death. 1,20 Older patients are especially susceptible to adverse drug events associated with inappropriate prescribing due to decreased drug metabolism, increased prevalence of hepatic/renal dysfunction, and the higher likelihood of drug-drug interactions as a result of polypharmacy.…”

“…DOACs require dosage adjustments for renal function, weight, age and concomitant medications 2–4 . Several studies have shown that DOACs are frequently prescribed incorrectly with inappropriate dosing varying from 12.8 to 42.8% of AF patients as well as other patients 3,5–19 . Inappropriate prescribing has been shown to be an independent risk factor for adverse drug events leading to potential clinical consequences including thromboembolism, bleeding, hospitalization and death 1,20 .…”

Effect of Oral Anticoagulants in Atrial Fibrillation Patients with Polypharmacy: A Meta-analysis

“…According to the predefined inclusion and exclusion criteria, we subsequently excluded seven studies because (1) article is a meta-analysis (n ¼ 1) 16 ; (2) studies did not report the relevant outcomes (n ¼ 3) [17][18][19] ; and (3) studies did not report the classification of polypharmacy (n ¼ 3). [20][21][22] Finally, a total of 12 studies were included in our meta-analysis. [8][9][10]15,[23][24][25][26][27][28][29][30]…”