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High rates of off-label doses seen in ED patients receiving DOACs

09 Jun 2020

Vitamin K antagonists (VKAs) are the most commonly used direct oral anticoagulant (DOAC), followed by rivaroxaban and apixaban, in the emergency department (ED), with a significant number of patients being prescribed off-label doses, according to a recent study.

“While no difference was found for the respective anticoagulants with respect to bleeding, concomitant aspirin use was a significant predictor for bleeding in our collective,” the investigators said.

This retrospective analysis included patients presenting to the ED between 1 January and 31 December 2018, with therapeutic DOAC (ie, VKA, rivaroxaban, apixaban, edoxaban, and dabigatran). The authors carried out a detailed chart review for each patient concerning characteristics, indication, and bleeding complications.

In total, 19,662 consecutive cases in the emergency department were reported, of which 1,721 (9 percent) were treated with DOAC. The most widely used anticoagulants were VKA (41 percent), rivaroxaban (36 percent), and apixaban (19 percent), while the most common indications were stroke prophylaxis in patients with atrial fibrillation (63.2 percent) and venous thromboembolism (24.1 percent).

No indication was identified in 27 patients (1.6 percent). Moreover, 32 percent were classified to have either off-label doses of OACs or an international normalized ratio out of range (in VKA). However, 20 percent were classified as off-label underdosed and 12 percent as overdosed.

There was no difference seen in the likelihood of bleeding on admission between the respective drugs. Concomitant use of aspirin was the only factor that correlated significantly with the presence and higher severity of bleeding.

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Most Read Articles
Elaine Soliven, 4 days ago

Switching from efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF) to the new bictegravir/ emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) regimen maintained high rates of virological suppression in adults who are living with HIV*, according to a study presented at AIDS 2020.

3 days ago
Among individuals with abdominal obesity, drinking beverages with artificial sweeteners (ASBs) or no sugar (USBs) instead of sugar-sweetened beverages (SSBs) helps lose body weight, a study has found. However, USBs have a more favourable effect on sweet taste preference compared with ASBs.
Stephen Padilla, 5 days ago
Pre-exposure prophylaxis (PrEP) containing either long-acting injectable cabotegravir (CAB) or tenofovir/emtricitabine (TDF/FTC) is safe and effective for transgender women (TGW) and cisgender men who have sex with men (MSM), but CAB results in a much lower HIV incidence compared to TDF/FTC, results of the HIV Prevention Trials Network (HPTN) 083 have shown.
Jairia Dela Cruz, 4 days ago
Monthly prophylaxis with the fixed-dose combination of naphthoquine-azithromycin (NQAZ) is well tolerated and confers significant protection against infection with Plasmodium parasites among individuals residing in malaria-endemic areas in Southeast Asia, as shown in the results of a phase III trial.