Rodrigo Zubieta-Rodríguez, Departamento de Medicina Interna, Hospital Alma Mater de Antioquia. Medellín, Colombia
Angie K. Pinto-Díaz, Departamento de Medicina Interna, Hospital Alma Mater de Antioquia. Medellín, Colombia
Ángel A. Ramírez-Rojas, Departamento de Medicina Interna, Hospital Alma Mater de Antioquia. Medellín, Colombia
Laura C. Gómez-Moreno, Departamento de Medicina Interna, Hospital Alma Mater de Antioquia. Medellín, Colombia
Héctor I. Mazo-Arteaga, Departamento de Medicina Interna, Hospital Alma Mater de Antioquia. Medellín, Colombia
Introduction: Direct oral anticoagulants have demonstrated a superior safety profile compared to warfarin; however, their efficacy and safety depend on appropriate administration. Clinical studies report a high prevalence of inappropriate prescribing, which is associated with an increased risk of adverse outcomes. Objective: To evaluate the appropriateness of direct oral anticoagulant prescriptions in patients with venous thromboembolism and/or atrial fibrillation. Methods: Retrospective observational cross-sectional study of hospitalized adult patients between August 1, 2023, and July 31, 2024, who were prescribed direct oral anticoagulants at discharge for atrial fibrillation and/or venous thromboembolism. Results: A total of 610 patients were included: 53.9% with atrial fibrillation, 41.2% with venous thromboembolism, and 4.9% with both conditions. Apixaban was prescribed in 76.9% of cases, rivaroxaban in 22.6%, and dabigatran in 0.5%. Inappropriate prescriptions were identified in 20.5% of cases, being more frequent in venous thromboembolism (27.5%) and in patients with both conditions (30%) than in atrial fibrillation (14.3%) (p = 0.001). The main causes of inappropriate prescription were the omission or incomplete loading administration in acute venous thromboembolism (42.4%), followed by subtherapeutic (29.6%) and supratherapeutic doses (18.4%). Conclusions: A high rate of inappropriate direct oral anticoagulant prescriptions was found in our institution. Implementing educational and monitoring strategies is crucial to optimizing the prescription of these medications and improving clinical outcomes.
Keywords: Inappropriate prescribing. Direct-acting oral anticoagulants. Atrial fibrillation. Venous thromboembolism.
