Millions of Americans rely on blood thinners, or anticoagulants, to prevent dangerous blood clots that can lead to heart attacks and strokes.
Among these, more than two-thirds use a specific kind called direct oral anticoagulants (DOACs).
Examples of DOACs include rivaroxaban, known by the brand name Xarelto, and apixaban, known as Eliquis. Despite their effectiveness, these medications are often not prescribed correctly, which can have serious, even life-threatening, consequences.
A recent study by Michigan Medicine highlights that up to one in eight patients are either under- or over-prescribed DOACs. This issue is particularly problematic after the initial prescription is written.
According to Dr. Geoffrey Barnes, a senior author of the study and associate professor of cardiology-internal medicine at the University of Michigan Medical School, while DOACs might seem easier to manage than traditional blood thinners like warfarin, it is crucial for healthcare providers to monitor these medications closely to prevent clotting or bleeding problems.
In hospitals across Michigan, it was found that incorrect dosing of DOACs was quite common, especially among patients with conditions like atrial fibrillation and venous thromboembolism, where blood clots form in veins.
Researchers analyzed five years of prescribing data from 2018 to 2022 through the Michigan Anticoagulant Improvement Initiative, a project supported by Blue Cross Blue Shield and Blue Care Network of Michigan.
They discovered that nearly 70% of the incorrect dosing alerts were generated during follow-up visits, rather than at the time of the initial prescription.
When healthcare providers were notified about these dosing errors, they made adjustments to the prescriptions about 75% of the time. However, the study also revealed that only 18% of these alerts actually led to contacting the prescriber.
Grace C. Herron, the study’s first author and a fourth-year student at the University of Michigan Medical School, pointed out that while many systems are designed to ensure proper medication dosing at the start, there is a lack of tools for ongoing monitoring.
DOACs, which have been available since 2010, gained popularity because they do not require regular blood tests to monitor their effectiveness, unlike traditional blood thinners.
However, they have complex dosing requirements that can change based on factors like kidney function and interactions with other medications. This complexity makes it crucial to have ongoing monitoring and adjustments.
Hospitals participating in the Michigan Anticoagulation Quality Improvement Initiative are at the forefront of national efforts to develop and test systems that ensure patients receive the safest and most appropriate blood thinner.
Nurses and pharmacists in these systems play a vital role in monitoring prescriptions and identifying potential issues, even months or years after the medication is first prescribed.
In summary, while DOACs offer convenience and effectiveness in preventing blood clots, they require careful and continuous management to avoid serious health risks. Proper monitoring and adjustments by healthcare providers are essential to ensure patient safety and the best possible outcomes.
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The research findings can be found in Thrombosis and Haemostasis.
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