Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants (DOACs)

Abstract

Abstract

Introduction: Anticoagulants are recommended to prevent stroke and systemic embolism in Atrial Fibrillation (AF) and are a significant cause of patient safety incidents. In recent years direct oral anticoagulants (DOACs) have been developed as an alternative to the more traditional anticoagulants, such as warfarin. Although clinical trials data shows a similar adverse drug reaction profile of DOACs and warfarin, real world observational evidences on Medicine Related Problems (MRPs) for DOACs are limited. Aim: The aim of this study is to investigate the nature and severity of MRPs among adult patients with AF on DOACs and to explore patients and health care professionals’ perspectives about DOACs usage and safety in order to make recommendations on ways to reduce the related MRPs. Materials and Method: A mixed method approach was used comprised of two phases. In Phase I, AF patients’ medical records at a hospital in the UK were reviewed. MRPs were identified and classified based on the Pharmaceutical Care Network Europe (PCNE) classification system. The severity of definite MRPs was assessed. Data was analysed using SPSS where descriptive statistics and logistic regression were applied. Phase II: Semi-structured interviews were conducted with adult patients having AF and being on direct oral anticoagulants and healthcare professionals in the UK hospital. Thematic content analysis was applied to the qualitative data using NVivo qualitative analysis software.

Results: Phase I: MRPs were prevalent in more than 50% of the studied population in the UK hospital. The majority of the MRPs were assessed to have moderate harm to patients. However, severe cases were 12.8% of the identified MRPs. The main cause of MRPs was Adverse Drug Reaction (ADR), and a number of risk factors were implicated: polypharmacy, independent living situation, and using of rivaroxaban. In phase II: three main themes emerged: Safety of DOACs, Education and Participation.

Conclusion: Medicine-related problems associated with DOACs among patients with AF in the UK hospital were significant. There is an urgent need to improve healthcare processes and reduce MRPs through the improvement of patient safety, and efficient interventions need to be implemented to mitigate these MRPs among these groups of patients.