Background: Anticoagulants are commonly used for the prevention of thrombosis. Anticoagulants are high alert medications which, if wrongly prescribed, can cause serious and sometimes fatal complications. Anticoagulation has become increasingly complex with the introduction of direct oral anticoagulants (DOACs). This can lead to errors such as inappropriate prescribing; unfamiliarity of DOAC doses and the different dosing strategies for different indications and the monitoring required when patients are prescribed these agents. Multidisciplinary strategies have been shown to improve safety.

Aims: To determine the level of compliance with the anticoagulation guidelines in a tertiary referral hospital in terms of appropriate prescribing and to review anticoagulation incidents.  

Methods: A drug chart review of patients >18 years old was performed to ascertain if anticoagulants were appropriately prescribed according to: indication, patient characteristics (renal function, weight, age) and drug-drug interactions. Patients on anticoagulants for prevention of hospital acquired thrombosis were excluded. Data collection was carried out in October 2020, using a pre-populated electronic form (Microsoft Forms). Data analysis was performed using Microsoft Excel. Incidents involving anticoagulants that were reported to the hospital quality system in 2020 were also reviewed.

Results: 448 drug charts were reviewed. Anticoagulation was prescribed in 22% (n=100). 16% of the patients had anticoagulation incorrectly prescribed and 5% of the patients had appropriate anticoagulation after intervention by the pharmacist (Figure 1).
Apixaban was the oral anticoagulant most prescribed (n=48) and 87.5% of its prescriptions were appropriate. Tinzaparin was the parenteral anticoagulant most frequently prescribed (n=24) and 62.5% of prescriptions were appropriate. Incorrect doses and dual prescription of anticoagulants were the most commonly reported anticoagulant incidents (Table 1).

Figure 1. Appropriate prescribing of anticoagulants.

Table 1. Anticoagulant prescribing incidents

Conclusions: Anticoagulants remain high risk medications and dedicated specialist pharmacists should be considered to support safe and efficacious prescribing.  

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/anticoagulation-stewardship-time-to-formalize-the-role/