ArticleIsrael journal of health policy research2019
Clinical pharmacist led hospital-wide direct oral anticoagulant stewardship program.
Article in Israel journal of health policy research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03527615 (Clinical Pharmacist Led Hospital-Wide Direct Oral Anticoagulant Stewardship Program), which is not on this map. Cited by 21 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Clinical Pharmacist Led Hospital-Wide Direct Oral Anticoagulant Stewardship Program
Who cites it
21 citing papers in PubMed.
- Utilization of Apixaban Pharmacokinetics for Dose Optimization in High-Risk Elderly Patients.Clinical pharmacokinetics · 2026Observational
- Exploring the knowledge level and practices of hospital pharmacists in management of oral anticoagulants in Gulf Cooperation Council countries: a scoping review of literature.Frontiers in public health · 2026Article
- Exploring the role of community pharmacists in perioperative management of antithrombotic agents: a qualitative study of barriers, facilitators, and future directions.International journal of clinical pharmacy · 2025Article
- Safe and effective anticoagulation use: case studies in anticoagulation stewardship.Journal of thrombosis and haemostasis : JTH · 2025Review
- Appropriateness of direct oral anticoagulant dosing in patients with atrial fibrillation at a tertiary care hospital in Thailand.Exploratory research in clinical and social pharmacy · 2024Article
- Challenges, Recommendations, and Epidemiology of Pulmonary Embolism in India: A Narrative Review.Cureus · 2024Review
- The Effect of Levetiracetam Compared with Enzyme-Inducing Antiseizure Medications on Apixaban and Rivaroxaban Peak Plasma Concentrations.CNS drugs · 2024Observational
- Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation.Open medicine (Warsaw, Poland) · 2023Article
- Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription.Research and practice in thrombosis and haemostasis · 2022Article
- Application of Novel Pharmacists' Risk in Pharmacotherapy (PHARIPH) Scale for Identification of Factors Affecting the Safety of Hospital Pharmacotherapy-An Observational Pilot Study.International journal of environmental research and public health · 2022Observational
- Prescribing Errors With Direct Oral Anticoagulants and Their Impact on the Risk of Bleeding in Patients With Atrial Fibrillation.Journal of cardiovascular pharmacology and therapeutics · 2021Article
- Seven key parameters that facilitate clinical pharmacy practice: a comparison between Israel and the United States.Israel journal of health policy research · 2021Article
- Enhancement and evaluation of a prescription audit system for direct oral anticoagulants using a check sheet.Journal of pharmaceutical health care and sciences · 2021Article
- Article
- The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.Journal of thrombosis and thrombolysis · 2020Article
- Quality of clinical direct oral anticoagulant prescribing and identification of risk factors for inappropriate prescriptions.British journal of clinical pharmacology · 2020Article
- Drug Therapy Problems and the Role of Clinical Pharmacist in Surgery Ward: Prospective Observational and Interventional Study.Drug, healthcare and patient safety · 2020Article
- Evaluation of Remote Pharmacist-Led Outpatient Service for Geriatric Patients on Rivaroxaban for Nonvalvular Atrial Fibrillation During the COVID-19 Pandemic.Frontiers in pharmacology · 2020Article
- Hospitalization as an opportunity to correct errors in anticoagulant treatment in patients with atrial fibrillation.British journal of clinical pharmacology · 2019Article
- Real-world assessment of off-label direct oral anticoagulant dosing for venous thromboembolism.Journal of thrombosis and thrombolysis · 2019Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn the past decade, direct-acting oral anticoagulants (DOAC) have been introduced to medical practice for several indications, with a wide range of dosing regimens. As both over- and under-dosing might lead to life-threatening events, development of methods promoting safe and effective utilization of these agents is imperative. The Hadassah Clinical Pharmacy team initiated a hospital-wide program, for monitoring and promoting safe and effective prescription of DOAC during hospitalization. This study describes the types of drug related problems addressed and the program's performance in terms of consultation rates and physician acceptance.
methodsElectronic medical records throughout the hospital were screened for DOAC orders. All DOAC orders were assessed by a clinical pharmacist for potentially-inappropriate prescribing. When potentially-inappropriate prescribing or a drug-related problem was identified, the clinical pharmacist provided consultation on management options. In specific cases, additional guidance was provided by coagulation and pharmacology specialists. Data on patient characteristics, clinical pharmacist consultations, and physician response was retrospectively retrieved for the first six months of 2017. Characteristics of patients with and without consultations were compared, consultations were categorized by the recommended management of the drug related problem, and physician acceptance rates were evaluated by category.
resultsDuring the evaluated period, 585 patients with DOAC orders were identified. Patients were evenly distributed by gender, and age averaged 78 years. Most patients received apixaban (75%) followed by rivaroxaban (14%) and dabigatran (11%), and most (63%) received "reduced dose" regimens. Clinical pharmacists provided 258 consultations for 210 patients, regarding anticoagulation management, such that more than one in three patients on DOAC had potentially inappropriate prescribing or drug related problems. Consultations included alerts regarding potentially inappropriate DOAC doses and recommendations to increase (29%) or decrease (5%) the dose, potentially inappropriate concomitant antiplatelet agents (20%), need for DOAC level monitoring (23%), and alerts regarding other drug related problems (23%). More than 70% of recommendations were accepted by the attending physician.
conclusionDue to the complexity of DOAC management, potentially-inappropriate prescribing and drug related problems are common. Multidisciplinary collaborative projects including review and consultation by clinical pharmacists are an effective method of improving management of patients on DOAC.
trial registrationRetrospectively registered at clinicaltrials.gov, NCT03527615 .
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.