Evaluation of the Appropriateness of Prescribing Direct Oral Anticoagulants at Songkhla Hospital

Abstract

Background: A review of adverse drug reactions from the use of direct oral anticoagulants (DOACs) between 2021 and 2022 at Songkhla Hospital revealed two cases of grade I adverse events, including death, necessitating the use of expensive antidotes, thereby impacting both patient lives and drug costs.

Objective: To evaluate the appropriateness of prescribing DOACs and to assess the incidence of adverse drug reactions.

Method: This was a retrospective descriptive study that collected data from electronic databases and patient medical records from October 1, 2022, to September 30, 2023.

Result: A total of 231 prescriptions were reviewed, with 208 (90.04%) being for appropriate doses and 23 (9.96%) for inappropriate doses. Among the inappropriate doses, 10 (4.33%) were underdosed, and 13 (5.63%) were overdosed. Adverse drug reactions were reported in 7 (3.03%) of the appropriately dosed patients, including 6 bleeding events (2.60%) and 1 case of swollen feet (0.43%). One bleeding event (0.43%) was reported in a patient who received an inappropriately dosed medication. Patients with inappropriate doses had 1.29-fold higher odds of experiencing adverse drug reactions compared to those with appropriate doses (OR = 1.29, 95%CI: 0.15 – 10.97).

Conclusion: Our study found that inappropriate prescribing of DOACs was associated with a 29% increased risk of adverse drug reactions compared to appropriate prescribing. While this finding did not reach statistical significance due to limitations in reported data, the small sample size, and the short observation period, it was a crucial reminder for physicians to be more aware when prescribing these medications.