Background: The use of Direct oral anticoagulants (DOACs) have been increasing due to its convenience and equivalent efficacy with warfarin. We would like to evaluate prescribing patterns of apixaban and rivaroxaban and to compare the efficacy and safety of these DOACs in our hospital.

Aims: To evaluate prescribing patterns, safety and efficacy of DOACs.

Methods: Retrospective analysis of patients newly initiated with DOACs and data was collected from the electronic database of the hospital. Prescribing patterns were evaluated for appropriateness based on product-insert leaflet (PIL) and FDA-approved recommendations. Primary efficacy outcomes were ischaemic stroke and any systemic embolism that occurred during the 1-year follow-up. Primary safety outcomes were any major or clinically relevant non-major bleeding.

Results: A total of 395 patients initiated with DOACs were identified with a median age of 72 (range 44-91 years old). 81 (20.5%) of them were switched from warfarin to DOAC and the choice of DOACs are Apixaban (n=303, n=76.7%) followed by Rivaroxaban (n=92, 23.3%). Most of the indications of anticoagulations are atrial fibrillation (n=350, 88.4%) followed by venous thromboembolism (n=35, 8.8%) and cardiovascular event (n=9, 2.3%) respectively. Most patients were male (n=218) with gender ratio of 1.2:1. 45.5% have normal BMI. Appropriate prescribing was identified in 289 patients (73.2%) of the patients and inappropriate prescribing was mainly attributed to under-dosing (16.5%). 93.6% of them were compliant to the treatment. Primary efficacy and safety outcomes were not significantly different between apixaban and rivaroxaban (Hazard ratio [HR] 0.756; 95% CI, 0.156-3.679; p = 0.729 for efficacy outcomes; Hazard ratio [HR], 0.828; 95% CI, 0.505-1.359; p = 0.456 for safety outcomes).  8 (2%) and 88 (22%) of them developed major bleeding and clinically relevant non-major bleeding, respectively.

Conclusions: Majority of the prescriptions for DOACs were in line with recommendations. Apixaban and rivaroxaban appeared to have similar efficacy and safety outcomes.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/prescribing-patterns-efficacy-and-safety-of-direct-oral-anticoagulants-doac-usage-in-a-tertiary-hospital/