Direct Oral Anticoagulants in Long-term Care Facilities: Rates of FDA-Approved Dosing

Abstract

Objective To determine rates of compliance with Food & Drug Administration (FDA)-approved dosing of direct oral anticoagulants (DOACs) in long-term care residents. Design A retrospective chart review of 90 patients, utilizing an electronic health record, and a longterm care pharmacy’s dispensing record. Patient electronic health records were reviewed to collect the following data: prescribed DOAC, dose, therapy duration, diagnosis, age, height, weight, and serum creatinine. This information was used to determine the FDA-recommended DOAC dose and recommended duration, which was compared with the prescribed dose and duration. Main Outcome Measure The rate of incorrect DOAC doses, defined as a discrepancy from the FDA-recommended dose, based on patient characteristics. Setting Two chains of long-term care facilities in Michigan, Ohio, North Carolina, Tennessee, and Virginia serviced by a long-term care pharmacy. PATIENTS: Patients prescribed one of three targeted DOACs (apixaban, rivaroxaban, or dabigatran) between August and October 2019. Patients had to be a resident within two long-term care chains. Results Thirty-three out of 90 residents were treated with an incorrect DOAC dose. This broke down into 20% of patients on a dose that was too low and 17% of patients on a dose that was too high. Conclusion The results of the study identify the need for pharmacists to closely review the dosing of DOACs and recommend therapeutic changes based on treatment guidelines.