Development and Evaluation of a Protocol for the Periprocedural Management of Direct Oral Anticoagulants for Percutaneous Coronary Procedures
Author(s): ,
Claudia Bucci
Affiliations:
BScPharm PharmD ACPR
,
Artemis Diamantouros
Affiliations:
BScPharm MEd PhD
,
Rita Selby
Affiliations:
MBBS FRCPC MSc
Sam Radhakrishnan
Affiliations:
MD
Canadian Pharmacists Conference ePoster Library. Lau G. Jun 3, 2017; 174242
Gloria Lau
Gloria Lau
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Abstract
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Objectives
Direct oral anticoagulants (DOACs) have emerged as recommended treatment for stroke prophylaxis in patients with non-valvular atrial fibrillation. Limited guidance exists regarding their peri-procedural management. At our institution, a pharmacy-developed guideline is available, but its use in practice is unknown. This study was conducted to evaluate its usability and identify the gap between the guideline and practice. Plasma DOAC concentrations were obtained to identify whether current recommendations resulted in DOAC levels that correlated with expected plasma concentrations reported in the literature

Methods
This prospective observational study describes the current management of patients on DOACs undergoing elective coronary procedures. Information that was collected included: the date and time of the last DOAC dose, patients' past medical history, medications; physicians' instructions for peri-procedural management, patient adherence and periprocedural complications. Descriptive statistics were used. Pre-procedural blood samples were collected to measure plasma DOAC concentrations using anti-factor Xa levels (rivaroxaban and apixaban) and the Hemoclot® Assay (dabigatran).

Results
Twenty-four patients were recruited between February and May 2016. Physicians' recommendations were consistent with our guideline in 12.5% patients suggesting that uptake on its use is low and/or inconsistently followed. Variability in physician practice was noted in the recommendations. Patient adherence to the recommendations was 70.8%. DOAC plasma concentrations of the study patients were consistently below reported 'on-therapy” trough ranges - an expected outcome for patients who were off therapy for at least 24 hours. There were no significant peri-procedural complications

Conclusion
The current institutional guideline for peri-procedural management of anticoagulants is used inconsistently in practice. Patient adherence to physicians' instructions is also inconsistent. The results of this study suggest that a revision to the institutional guideline is needed to improve its usability. Furthermore, patient education needs to be improved to increase adherence. The coagulation tests results will add to our growing knowledge of peri-procedural use of DOACs.

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