Category: Professional Posters
Purpose: The MMUH formulary recommendations for OACs are in line with the Health Service Executive (HSE) Medicines Management Programme (1,2). Warfarin is the OAC of choice. Apixaban is the preferred Direct Oral Anticoagulant (DOAC) if warfarin is unsuitable. Edoxaban, dabigatran and rivaroxaban are third-line options (1,2). In 2014, warfarin was prescribed in 81% of cases in the MMUH. National data indicates DOACs are now prescribed more often than warfarin (2).
To identify current MMUH OAC prescribing practice and compare results with 2014 data.
Methods: A point prevalence audit was completed in November 2018 by clinical pharmacists, across thirty wards on all patients on OACs. The OAC, indication, dose, prescribing team speciality and if treatment was commenced on this MMUH admission were recorded. Results were collated, analysed and compared with an identical 2014 audit.
Results: More MMUH patients were prescribed OACs in 2018 (n=87) than 2014 (n=53).
Apixaban was the most commonly prescribed OAC (48%), followed by rivaroxaban (20%), warfarin (16%), dabigatran (14%) and edoxaban (2%). In 2014, warfarin was the most commonly prescribed OAC (81%), followed by rivaroxaban (15%), apixaban (2%) and dabigatran (2%).
The Medicines for the Elderly speciality had the most patients on OACs in both 2018 (n=29) and 2014 (n=14). Atrial fibrillation remains the most common indication for oral anticoagulation. The majority of patients prescribed OACs in both 2014 and 2018 were 60 years or over. In 2014, all patients under 60 requiring oral anticoagulation were on warfarin. In 2018, all these patients were on DOACs.
The number of patients starting OACs during MMUH admission was approximately 10% higher in 2018 than 2014.
Conclusion: Apixaban is the most commonly prescribed OAC in the MMUH. Use of warfarin has decreased from 81% in 2014 to 16% in 2018 and is now surpassed by DOAC prescribing.