Hospitalization as an opportunity to correct errors in anticoagulant treatment in patients with atrial fibrillation

Abstract

lant therapy among patients with atrial fibrillation (AF). Methods: Our cohort included patients admitted to our institution with a history of AF between 2016 and 2018. We categorized patient's treatment upon admission and discharge as lacking (no treatment despite indication), inadequate (according to individual characteristics) or adequate. We assessed adequacy of treatment upon discharge and determined factors associated with correcting admission errors. Results: Of 4427 patients admitted with a history of AF, the categorization to lacking, inadequate and adequate treatment was 1746 (39.4%), 1237 (27.9%) and 1444 (32.6%) patients, respectively. Of those with inadequate treatment, the most common types of errors were direct oral anticoagulant (DOAC) underdosing (n = 578; 46.7%), vitamin-K antagonists when DOAC was indicated (n = 258; 20.9%), DOAC despite contraindication to DOAC (n = 166; 13.4%) and DOAC overdosing (n = 124; 10%). Upon discharge 688 (18.6%, out of n = 3694) corrections but also 316 (8.6%) new mistakes were found. On multivariate logistic regression, the factors associated with correction of an error on admission were hospitalization due to AF (odds ratio [OR] 2.94 [2.39-3.61]), hospitalization in the neurologic or geriatric wards (OR 2.79 [2.04-3.80]), female sex (OR 1.34 [1.10-1.63]) and a history of stroke (OR 1.47 [1.17-1.86]), while the presence of a contraindication to DOAC decreased the chance of correction (OR 0.10 [0.06-0.18]). Conclusion: Hospitalization for any reason may contribute to correction of errors in AC treatment in patients with AF. Unfortunately, a significant portion of patients remains inadequately treated by both outpatient and inpatient providers.

Medication errors associated with direct-acting oral anticoagulants: analysis of data from national pharmacovigilance and local incidents reporting databases

“…In France, a prospective nationwide cohort study in primary care reported that 39% of the patients received at least one inappropriate DOAC prescription, mostly were inappropriate underdosing [ 21 ]. Another cross‐sectional study of oral anticoagulant use in patients with AF demonstrated underdosing in 13.1% of prescriptions, and unfortunately, 39.4% of their patients had not been prescribed an indicated DOACs [ 22 ].…”

Prescribing Errors With Direct Oral Anticoagulants and Their Impact on the Risk of Bleeding in Patients With Atrial Fibrillation

“…A similar prevalence was noted in another study from Israel, where DOAC underdosing was detected among 13% of hospitalized patients with AF. 41 A previous study has summarized the results of a review made by clinical pharmacists to DOAC orders among patients in our hospital. Nearly 30% of the consultations included recommendations for increasing the dose.…”

The association between increasing oral anticoagulant prescribing and atrial fibrillation related stroke in Ireland

“…33 In a UK study which enrolled hospitalised patients with AF, only 32.6% had adequate OAC treatment on admission, with DOAC underdosing as the most common error. 34 Thirdly, less interaction with the healthcare system and less monitoring should be considered as factors. It has been shown that a warfarin clinic is associated with improved OAC adherence compared with community-based care.…”