■处方DOAC在老年人和肾和肝损害患者中面临挑战。为了降低安全风险,药剂师在检测中发挥作用,预防,和DOAC相关药物相关问题(DRP)的解决。
■为了确定接受DOAC治疗的患者中DOAC相关DRPs的类型以及使患者易患DOAC相关DRPs的因素。
■从2017年1月1日至2019年5月31日,在SGH中对服用DOAC(利伐沙班,达比加群,和阿哌沙班)。数据是以电子方式提取的,用于患者的人口统计学,临床特征,以及药剂师确定的DOAC相关DRP的详细信息。DRP组和非DRP组的性别匹配比例为1:2,种族,并进行DOAC。DRP组包括检测到DRP的患者,而非DRP组包括没有检测到DRP的患者。描述性分析用于总结DOAC相关DRPs的患者特征和类型。在匹配的人群中,使用条件逻辑回归来计算未调整(UOR)和调整后的比值(AOR)比率,以检测DOAC相关DRPs与年龄的关联,肾功能,≥2合并症,和DOAC指征(心房颤动[AF]与静脉血栓栓塞)。
■共分析了8432名服用DOAC的患者,其中包括827名(9.8%)和7602名(90.2%)患有DRP和无DRP的患者,分别。与DOAC相关的DRP最高的是不适当的药物治疗方案(n=487,60.1%)。匹配后,对2403例患者进行了分析,包括来自DRP组的801例患者和来自非DRP组的1602例患者。与DOAC相关的DRP相关的因素对肌酐清除率(CrCl)>30至50mL/min/1.73m2时的肾功能具有统计学意义(AOR:1.42;95%CI:1.14-1.76;P=0.002),15至30mL/min/1.73m2(OR:1.94;95%CI:1.42-2.66;P<.001),且<15mL/min/1.73m2(OR:2.35;95%CI:1.13-4.88;P=0.022),分别,与CrCl>50mL/min/1.73m2和DOAC指征AF(AOR:1.84;95%CI:1.47-2.30;P<.001)相比静脉血栓栓塞。
■不适当的药物方案是最常见的DOAC相关DRP。肾功能受损和房颤患者发生DOAC相关DRPs的可能性增加。
UNASSIGNED: Prescribing DOACs presents with challenges in the elderly and patients with renal and hepatic impairment. To mitigate safety risks, pharmacists have a role in detection, prevention, and resolution of DOAC-associated drug-related problems (DRPs).
UNASSIGNED: To identify the types of DOAC-associated DRPs in patients on DOAC therapy and factors that predispose patients to DOAC-associated DRPs.
UNASSIGNED: An observational cross-sectional study was conducted in SGH from January 1, 2017, to May 31, 2019, on patients prescribed with a DOAC (rivaroxaban, dabigatran, and apixaban). Data were electronically extracted for patient demographics, clinical characteristics, and details of DOAC-related DRPs identified by pharmacists. Matching of DRP group to non-DRP group at a ratio of 1:2 based on gender, race, and DOAC was performed. The DRP group included patients with detected DRPs while non-DRP group included patients without them. Descriptive analysis was used to summarize patient characteristics and types of DOAC-associated DRPs. In the matched population, conditional logistic regression was used to calculate unadjusted (UOR) and adjusted odds (AOR) ratio to detect association of DOAC-associated DRPs with age, renal function, ≥2 comorbidities, and DOAC indication (atrial fibrillation [AF] vs venous thromboembolism).
UNASSIGNED: A total of 8432 patients prescribed DOACs were analyzed, which consisted of 827 (9.8%) and 7602 (90.2%) patients with DRPs and no DRPs, respectively. The top DOAC-associated DRP was inappropriate drug regimen (n = 487, 60.1%). After matching, 2403 patients were analyzed, consisting of 801 patients from DRP group and 1602 from non-DRP group. Factors associated with DOAC-associated DRPs were statistically significant for renal function at creatinine clearance (CrCl) of >30 to 50 mL/min/1.73 m2 (AOR: 1.42; 95% CI: 1.14-1.76; P = .002), 15 to 30 mL/min/1.73 m2 (OR: 1.94; 95% CI: 1.42-2.66; P < .001), and <15 mL/min/1.73m2 (OR: 2.35; 95% CI: 1.13-4.88; P = .022), respectively, compared with a CrCl of >50 mL/min/1.73 m2 and DOAC indication for AF (AOR: 1.84; 95% CI: 1.47-2.30; P < .001) compared with venous thromboembolism.
UNASSIGNED: Inappropriate drug regimen was the most common DOAC-associated DRP. Impaired renal function and patients with AF increased the likelihood of DOAC-associated DRPs.