Prescribing practices and patient perception of anticoagulant treatment in the older population

Abstract

Direct acting oral anticoagulants (DOACs) are a class of oral anticoagulants designed to be a more tolerated alternative to warfarin. The main patient group of DOACs are older patients who are at risk of disorders such as atrial fibrillation, deep vein thrombosis and pulmonary embolism. The continuous release of evidence and the introduction of generic options of DOACs are increasing the prescription rate of DOACs. The aim of this study is to review the prescribing practices of DOACs in the older population and evaluate patient experience. Retrospective quantitative data for prescribing of DOACs was collected from pharmacy patient profiles at Karin Grech Hospital for Phase 1 of the study. Selection criteria were age 60 years or over and long-term oral anticoagulation. Qualitative data on patient experience with oral anticoagulants was collected using a validated questionnaire over the phone for Phase 2. The patients selected were discharged from KGH for more than 3 months, were on long-term anticoagulation and had no cognitive, hearing or speaking impairment. Statistical analysis was carried out using IBM SPSS and Microsoft Excel. The endpoint of the study is to establish trends highlighting areas of improvement in the prescribing and administration of DOACs in Malta. 499 patients were assessed in Phase 1 from 2019 to 2021. The percentage of patients on DOACs in the study population increased from 24% in 2019 to 51% in 2021. The majority of patients had renal impairment. The percentage of appropriate doses being prescribed to DOAC patients increased from 68% to 87% of the patient population, from 2019 to 2021. 50 patients were investigated in Phase 2 of the study. The DOAC group was shown to be more aware of the benefits of DOACs compared to patients on warfarin. Consumption of DOACs in pharmacies has increased over the past years. The appropriateness of dosing is important to ensure older patients receive appropriate treatment. DOACs have recently been added to the National Formulary in Malta so that the use of these agents is expected to increase further.