Abstract：
BACKGROUND: Direct oral anticoagulants (DOACs) are increasingly used and can be involved in clinically relevant drug-drug interactions (DDIs) that increase the risk of major bleeding or thromboembolism. Skilled drug interaction management is essential to ensure safe and effective use of DOACs. In this study, we aimed to investigate the impact of the detection and management of DDIs with DOACs in a real-life community pharmacy setting on the pharmacotherapy of DOAC users.
METHODS: We conducted an intervention study in 201 community pharmacies in Belgium. On random days, patients purchasing DOACs or drugs known to interact with them were screened. When a DDI with the DOAC was detected, the pharmacist contacted the prescribing physician to discuss the management of the interaction. A previously developed practice-oriented DDI list accompanied by management plans for ambulatory care was used for both screening and management of the DDIs.
RESULTS: In total, 751 patients were included, among whom 875 DDIs were identified, primarily pharmacodynamic DDIs (95.7 %). Predominant interacting drug classes included selective serotonin or serotonin and norepinephrine reuptake inhibitors (32.9 %), antiplatelets (30.9 %), and non-steroidal anti-inflammatory drugs (28.9 %). In 43.0 % of DDIs, an intervention was decided upon. At three-month follow-up, proposed pharmacotherapy changes had been implemented in 79.1 % of these DDIs.
CONCLUSIONS: This study demonstrates that active screening and management of DDIs with DOACs in community pharmacies, in close collaboration with prescribing physicians, resulted in changes in pharmacotherapy in a substantial number of patients. This may contribute significantly to the safer utilisation of DOACs in high-risk populations.
METHODS: We conducted an intervention study in 201 community pharmacies in Belgium. On random days, patients purchasing DOACs or drugs known to interact with them were screened. When a DDI with the DOAC was detected, the pharmacist contacted the prescribing physician to discuss the management of the interaction. A previously developed practice-oriented DDI list accompanied by management plans for ambulatory care was used for both screening and management of the DDIs.
RESULTS: In total, 751 patients were included, among whom 875 DDIs were identified, primarily pharmacodynamic DDIs (95.7 %). Predominant interacting drug classes included selective serotonin or serotonin and norepinephrine reuptake inhibitors (32.9 %), antiplatelets (30.9 %), and non-steroidal anti-inflammatory drugs (28.9 %). In 43.0 % of DDIs, an intervention was decided upon. At three-month follow-up, proposed pharmacotherapy changes had been implemented in 79.1 % of these DDIs.
CONCLUSIONS: This study demonstrates that active screening and management of DDIs with DOACs in community pharmacies, in close collaboration with prescribing physicians, resulted in changes in pharmacotherapy in a substantial number of patients. This may contribute significantly to the safer utilisation of DOACs in high-risk populations.
摘要：
背景：直接口服抗凝剂（DOAC）的使用越来越多，并且可能涉及临床相关的药物-药物相互作用（DDI），从而增加大出血或血栓栓塞的风险。熟练的药物相互作用管理对于确保DOAC的安全有效使用至关重要。在这项研究中,我们旨在调查在现实生活中的社区药房环境中使用DOAC检测和管理DDI对DOAC使用者的药物治疗的影响.
方法：我们在比利时的201家社区药房进行了一项干预研究。在随机的日子里，筛查了购买DOAC或已知与之相互作用的药物的患者。当检测到带有DOAC的DDI时，药剂师联系了处方医生，讨论了相互作用的管理。先前开发的以实践为导向的DDI清单以及门诊护理管理计划被用于DDI的筛查和管理。
结果：总计，包括751名患者，其中确定了875个DDI，主要是药效学DDIs（95.7%）。主要的相互作用药物类别包括选择性5-羟色胺或5-羟色胺和去甲肾上腺素再摄取抑制剂（32.9%），抗血小板（30.9%），和非甾体抗炎药（28.9％）。在43.0%的DDI中，决定进行干预。在三个月的随访中，79.1%的DDI实施了拟议的药物治疗变更.
结论：本研究表明，在社区药房使用DOAC积极筛查和管理DDI，与处方医生密切合作，导致大量患者的药物治疗发生变化。这可能大大有助于在高风险人群中更安全地利用DOAC。
方法：我们在比利时的201家社区药房进行了一项干预研究。在随机的日子里，筛查了购买DOAC或已知与之相互作用的药物的患者。当检测到带有DOAC的DDI时，药剂师联系了处方医生，讨论了相互作用的管理。先前开发的以实践为导向的DDI清单以及门诊护理管理计划被用于DDI的筛查和管理。
结果：总计，包括751名患者，其中确定了875个DDI，主要是药效学DDIs（95.7%）。主要的相互作用药物类别包括选择性5-羟色胺或5-羟色胺和去甲肾上腺素再摄取抑制剂（32.9%），抗血小板（30.9%），和非甾体抗炎药（28.9％）。在43.0%的DDI中，决定进行干预。在三个月的随访中，79.1%的DDI实施了拟议的药物治疗变更.
结论：本研究表明，在社区药房使用DOAC积极筛查和管理DDI，与处方医生密切合作，导致大量患者的药物治疗发生变化。这可能大大有助于在高风险人群中更安全地利用DOAC。
