Standardized Direct Oral Anticoagulants Prescription for the Treatment of Acute Deep Vein Thrombosis in the Emergency Department: A Quality Improvement Initiative

C. Simard¹, L. Poirier-Blanchette¹, T. Cafaro², R. Kerzner³, H. Mantzanis³, M. Koolian²

¹McGill University, Faculty of Medicine, Montreal, Canada, ²McGill University, Jewish General Hospital, Division of General Internal Medicine, Department of Medicine, Montreal, Canada, ³Jewish General Hospital, Department of Pharmacy, Montreal, Canada

Abstract Number: PB1282

Meeting: ISTH 2021 Congress

Theme: Venous Thromboembolism » VTE Treatment

Background: Acute deep vein thrombosis (DVT) is a frequently encountered pathology and current guidelines support the use of direct oral anticoagulants (DOAC) as the mainstay of therapy. Studies have demonstrated significant rates of inappropriate DOAC prescriptions in this and other populations. Standardized prescriptions have shown to decrease the incidence of prescription errors in different contexts.

Aims: To determine the impact of a standardized prescription on inappropriate DOAC prescriptions in patients with acute DVT discharged from the Emergency Department (ED).

Methods: We conducted a retrospective study of patients with acute DVT discharged with a DOAC from the ED between December 27^th, 2019 and December 27^th, 2020 following the implementation of a standardized DOAC prescription. The impact of the prescription was measured using the absolute risk reduction (ARR) in the proportion of inappropriate prescriptions between pre- and post-implementation periods. Results from a previous audit of DOAC prescription appropriateness were used for the pre-implementation period. Appropriateness was determined using the Medication Appropriateness Index (MAI) with categories: A for appropriate, B for inappropriate with limited clinical significance, and C for inappropriate.

Results: A total of 28 patients discharged from the ED with acute DVT were prescribed a DOAC. Among the prescriptions, 3/28 (10.7%) were categorized as B compared to 24/44 (54.0%) pre-implementation (ARR 43.3%), 1/28 (3.6%) met at least one B and one C compared to 5/44 (11.3%) pre-implementation (ARR 7.7%) and 1/28 (3.6%) was categorized as C compared to 10/44 (22.7%) pre-implementation (ARR 19.1%). The proportion of prescriptions that used the standardized prescription was 8/28 (28.6%) and increased with time.

Conclusions: A standardized prescription reduces inappropriate DOAC prescriptions in patients with acute DVT. While a secular decrease is expected as clinicians become more familiar with this class of drugs, a standardized prescription likely enhances this effect and offers a promising avenue to improve patient safety outcomes.

To cite this abstract in AMA style:

Simard C, Poirier-Blanchette L, Cafaro T, Kerzner R, Mantzanis H, Koolian M. Standardized Direct Oral Anticoagulants Prescription for the Treatment of Acute Deep Vein Thrombosis in the Emergency Department: A Quality Improvement Initiative [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/standardized-direct-oral-anticoagulants-prescription-for-the-treatment-of-acute-deep-vein-thrombosis-in-the-emergency-department-a-quality-improvement-initiative/. Accessed November 29, 2023.

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