Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY-Reference-Cited by-同舟云学术

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

Published:2021-07-29 Issue: Volume: Page:
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Author:

,Fisher Louis^ORCID,Speed Victoria,Curtis Helen J^ORCID,Rentsch Christopher T^ORCID,Wong Angel YS^ORCID,Schultze Anna^ORCID,Massey Jon^ORCID,Inglesby Peter,Morton Caroline E^ORCID,Wood Marion,Walker Alex J^ORCID,Morley Jessica,Mehrkar Amir^ORCID,Bacon Seb^ORCID,Hickman George,Bates Chris^ORCID,Croker Richard^ORCID,Evans David,Ward Tom,Cockburn Jonathan^ORCID,Davy Simon,Bhaskaran Krishnan^ORCID,Smith Becky,Williamson Elizabeth,Hulme William^ORCID,Green Amelia^ORCID,Eggo Rosalind M^ORCID,Forbes Harriet^ORCID,Tazare John^ORCID,Parry John,Hester Frank,Harper Sam,Meadows Jonathan,O’Hanlon Shaun^ORCID,Eavis Alex^ORCID,Jarvis Richard^ORCID,Avramov Dima^ORCID,Griffiths Paul^ORCID,Fowles Aaron^ORCID,Parkes Nasreen,Douglas Ian J^ORCID,Evans Stephen JW^ORCID,Tomlinson Laurie^ORCID,MacKenna Brian^ORCID,Smeeth Liam^ORCID,Goldacre Ben^ORCID

Abstract

AbstractNational guidance was issued during the COVID-19 pandemic to switch patients on warfarin to direct oral anticoagulants (DOACs) where appropriate as these require less frequent blood testing. DOACs are not recommended for patients with mechanical heart valves. We conducted a retrospective cohort study of DOAC prescribing in people with a record of a mechanical heart valve between September 2019 and May 2021, and describe the characteristics of this population. We identified 15,457 individuals with a mechanical heart valve recorded in their records, of whom 1058 (6.8%) had been prescribed a DOAC during the study period. 767 individuals with a record of a mechanical heart valve were currently prescribed a DOAC as of May 31st 2021. This is suggestive of inappropriate prescribing of DOACs in individuals with mechanical heart valves. Direct alerts have been issued to clinicians through their EHR software informing the issue. We show that the OpenSAFELY platform can be used for rapid audit and feedback to mitigate the indirect health impacts of COVID-19 on the NHS. We will monitor changes in prescribing for this risk group over the following months.

Publisher

Cold Spring Harbor Laboratory

Reference22 articles.

1. Clinical guide for the management of anticoagulant services during the coronavirus pandemic. NHS England https://www.nice.org.uk/Media/Default/About/COVID-19/Specialty-guides/specialty-guide-anticoagulant-services-and-coronavirus.pdf.

2. OpenSAFELY: impact of national guidance on switching from warfarin to direct oral anticoagulants (DOACs) in early phase of COVID-19 pandemic in England

3. Mechanical or Artificial Valves. OpenCodelists https://www.opencodelists.org/codelist/opensafely/mechanical-or-artificial-valves/0ee582f8/.

4. Direct Acting Oral Anticoagulants (DOAC). OpenCodelists https://www.opencodelists.org/codelist/opensafely/direct-acting-oral-anticoagulants-doac/2020-10-05/.