Prescribing of Direct Oral Anticoagulants for the Prevention of Stroke in Patients with Atrial Fibrillation

Abstract

Abstract

Background: Direct oral anticoagulants (DOACs) have become the preferred option for stroke and systemic embolism prevention in patients with non-valvular atrial fibrillation (NVAF). However, each DOAC has its own individual dosing schedule for dose reduction, based on patients’ age, weight, renal function and concurrent medication. This could lead to increased risk of prescribing errors. This audit aims to investigate the appropriateness of DOAC dosing in patients with ischaemic stroke or transient ischemic attack (TIA) with NVAF.

Method: The audit included 57 adult patients discharged from the acute stroke ward at the Queen Elizabeth University Hospital between May 2020 and February 2021 who were prescribed DOAC for stroke or TIA with NVAF. The data were collected retrospectively using the patient’s case notes on the clinical portal. Data were analysed using Microsoft Excel. Results: Of 57, 8 patients (14%) were admitted on DOAC doses and 6 patients (11%) were discharged with DOACs doses, both of which were not as per the manufacturer’s recommendations, and only 3 patients (5%) were prescribed verapamil, which were appropriate doses as per the recommendations. Conclusion: The results showed that the majority of DOAC doses were appropriate as per the manufacturer’s recommendation, with a significant minority of inappropriate DOAC dose prescribed. Future work should be carried out to explore the causes and the outcomes associated with inappropriate DOAC dosing and strategies to avoid unintentional inappropriate DOAC prescribing using a quality improvement approach.