Category: Federal Forum Posters
Purpose: The Martinsburg Veteran Affairs Medical Center has recently implemented a prior authorization review process for the initiation of direct oral anticoagulants using national criteria for use. This offers an opportunity to review potential safety outcome impacts of criteria for use and prior authorizations. The objective of this study is to determine if the prior authorization drug review process impacts rates of major bleeding in newly initiated direct oral anticoagulant therapy.
Methods: This single center, retrospective review will be submitted to the Institutional Review Board for approval. The anticoagulant medications impacted by the prior authorization process are edoxaban, apixaban, rivaroxaban, and dabigatran. Patients included will be those prescribed a listed anticoagulant medication in the outpatient setting after the start of the prior authorization review process. Six months of data will be evaluated to a comparator group of patients randomly sampled from those initiated on the listed anticoagulants in the year preceding prior authorization implementation. Patients prescribed a direct oral anticoagulant for total hip or knee replacement will be excluded. Patient age, gender, ethnicity, medication profile, lab tests, diagnoses, and documented allergies and adverse reactions will be collected. All data will be recorded without patient identifiers and maintained in a secured, confidential electronic file. Hospital admission documentation will be reviewed to identify bleeding events. The primary outcome of this study will be the rate of major bleeding events per 100 patient years. Secondary outcomes will be the rate of non-major bleeding events per 100 patient years, rate of myocardial infarction per 100 patient years, number of initiations that meet criteria for use, and reason(s) any initiations did not meet criteria for use.
Results: not applicable
Conclusion: not applicable
William Gage– Pharmacy Resident, Martinsburg Veterans Affairs Medical Center, Winchester, VA