Category: Federal Forum Posters
Purpose: The prevalence of off-label dosing of DOACs in the Veteran population is not known. A recent study in the civilian population indicates a significant number of patients prescribed DOACs for stroke prophylaxis in non-valvular atrial fibrillation were not dosed according to package labeling, and off-label dosing was associated with increased adverse events. The primary objective is to identify whether DOACs prescribed in an outpatient Veteran population for non-valvular AF are dosed according to VA national criteria for use (CFU). The secondary objective is to compare rates of inappropriate dosing before and after implementation of a novel systematic drug ordering process.
Methods: This retrospective chart review has been submitted for Institutional Review Board approval, and will include a quasi-experimental before and after component. Up to 600 patient charts will be screened to reach target enrollment of 200 patients. Veterans aged 18 and older with nonvalvular AF treated with a DOAC for cardioembolic stroke prevention will be included. Patients will be categorized by initial DOAC dosing prescribed at baseline based on VA CFU as either dosed appropriately or inappropriately. Dosing will be classified as inappropriate if VA CFU recommends a DOAC be avoided or if a contraindication is present. Contraindications to DOAC treatment include active pathological bleeding, severe hypersensitivity reaction to any DOAC, select drug interactions, and various degrees of renal dysfunction specific to each DOAC. The primary endpoint will be percentage of patients dosed appropriately according to VA CFU. The secondary endpoint will be percentage of patients dosed inappropriately according to VA CFU before and after implementation of the novel systematic drug ordering process. The descriptive primary endpoint will be described as percentages. For the secondary endpoint, the percentage of patients dosed off label before and after implementation of the novel systematic drug ordering process will be compared using the chi-squared test.
Results: not applicable
Conclusion: not applicable
Bradley Briggs– PGY1 Pharmacy Resident, Veterans Health Care System of the Ozarks, Fayetteville, AR