Oversight of DOAC Prescribing Beneficial for A-Fib, VTE Patients

MONDAY, Aug. 5, 2024 (HealthDay News) -- Direct oral anticoagulant (DOAC) prescribing oversight for off-label prescribing is beneficial while patients are prescribed DOAC, according to a study published online July 30 in Thrombosis and Haemostasis.

Grace C. Herron, from the Frankel Cardiovascular Center at the University of Michigan in Ann Arbor, and colleagues evaluated data from the Michigan Anticoagulation Quality Improvement Initiative (MAQI²) registry to better characterize when off-label DOAC dosing is occurring and examine the effectiveness of prescribing oversight. The number of alerts generated in response to dosing deviations from the U.S. Food and Drug Administration instructions for atrial fibrillation (AF) and venous thromboembolism (VTE) was examined.

The researchers found that off-label dosing was relatively common among a sample of 789 to 1,022 annual AF patients and 381 to 484 annual VTE patients prescribed a DOAC in the MAQI² registry. From 2018 to 2022, there were 569 and 162 alerts for AF and VTE patients, respectively. In AF patients, alerts occurred more frequently during follow-up than at initial prescribing (78.2 versus 21.8 percent), while in VTE patients, alerts were more common at initial prescribing (59.9 versus 40.1 percent). Overall, 19.3 and 14.8 percent of AF and VTE alerts, respectively resulted in contact to the prescriber; when the prescriber was contacted, it led to an intervention about 75 percent of the time, with a change in DOAC dosing the most common intervention.

"Oversight of DOAC prescribing using a registry-based approach is effective in identifying errors and initiating the chain of events prompting prescribers to correct errors," the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

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