A research study suggests that using an online panel can help doctors and pharmacists treating people with blood thinners reduce the rate of inappropriate doses, as well as the blood clots and strokes that can result from them.
The online dashboard, developed by the U.S. Veterans Health Administration in 2016, was designed to highlight and optimize the treatment of patients with direct oral anticoagulants, or DOACs, the most commonly prescribed anticoagulants.
Researchers led by Michigan Medicine used the tool to evaluate more than 120,000 cases in which patients with atrial fibrillation or venous thromboembolism (blood clots in the veins) were treated with DOACs at 123 VA hospitals from mid-2015 to 2019.
They found that between 6.9 and 8.6% of patients received incorrect prescriptions for anticoagulants.
Adoption of the DOAC electronic patient management tool resulted in a decrease in unauthorized doses of around 8%. The rate of blood clots and strokes also decreased in all hospitals that implemented the tracking tool.
The results are published in the Journal of the American Heart Association.
“While DOACs are life-saving medications for patients with common thrombotic conditions, they can also cause serious harm when prescribed inappropriately,” said Geoffrey Barnes, M.D., M.Sc., first author and associate professor of cardiology and medicine. intern at the UM School of Medicine. in a statement. “Our study not only shows how frequently unauthorized doses of DOACs occur, but also highlights that the use of this DOAC population health management tool can reduce this rate of inappropriate doses, as well as subsequent complications. , such as stroke and clotting.
Direct oral anticoagulants can be prescribed incorrectly up to 20% of the time.
The two most prescribed DOACs are rivaroxaban (brand name Xarelto) and apixaban (brand name Eliquis).
Sites that used the system longer demonstrated a more significant decrease in inappropriate prescribing.
In Michigan, the Michigan Anticoagulation Quality Improvement Initiative, a multicenter collaboration of hospitals across the state, created a similar dashboard using the Epic EHR.
Five hospitals across the state currently use that system, including University of Michigan Health. Data on patients receiving anticoagulant treatment at participating outpatient clinics are entered into a clinical registry at the MAQI2 Coordinating Center, which is located within the Michigan Cardiovascular Outcomes Research and Reporting Program (MCORRP) at the University of Michigan.
Several quality metrics are used to compare performance between sites. Participating sites meet quarterly to review quality metrics, share best practices, and learn about the latest guidelines and research on anticoagulation management. Quality improvement initiatives are carried out to improve patient outcomes and reduce healthcare costs.
“This study provides one of the largest and most impactful evaluations of an anticoagulation management effort to show reduction in adverse clinical events,” Barnes added. “Health systems and policymakers should consider investing in anticoagulation management efforts that support pharmacists to review and correct doses of off-label direct oral anticoagulants for the benefit of millions of patients taking these medications. “.
