Drug utilization evaluation of Rivaroxaban in both inpatient and outpatient settings: Using standard guidelines

Objectives: Stroke-related atrial fibrillation (AF), deep vein thrombosis (DVT), and pulmonary thromboembolism (PE) are among the most common thromboembolic events. recently, direct oral anticoagulants (DOACs) have been slowly replacing warfarin. Rivaroxaban is a DOAC frequently prescribes to control thrombotic events. The safety and efficacy of Rivaroxaban are dependent on appropriate prescription, dosage, and other factors. This study is aimed to evaluate the Rivaroxaban utilization based on the standard protocol in both inpatient and outpatient settings. Methods: This cross-sectional/observational study was conducted for six months from ۱st August ۲۰۱۸ to ۱st February ۲۰۱۹ at a private hospital and an outpatient clinic in Shiraz, Iran. First, the clinical pharmacist defined a standard protocol for Rivaroxaban utilization and several indexes (۹ indexes for Non-valvular AF (NVAF) patients and ۱۰ indexes for DVT/PE patients). Second, participants were classified into three groups (NVAF inpatients, NVAF outpatients, and DVT/PE patients). Finally, the compliance percentage of each group was evaluated accordingly.Results: ۲۴۱ patients who were eligible lastly entered the study. Most patients (N=۲۰۸), were NVAF. Rivaroxaban utilization was overall appropriate in ۷۱.۹%, ۶۵.۸%, and ۵۰.۶% of patients within groups ۱, ۲, and ۳, respectively. Although medication interaction, administration regarding time/meal, and dose adjustment based on renal function showed the lowest compliance, the monitoring laboratory data and considering the underlying disorders were completely matchable with the protocol.Conclusions: This study showed some critical errors in both settings, especially in DVT/PE patients (۴۹.۴% no match). Hence, the most productive collaboration must be developed between clinical pharmacists and practitioners.

کلیدواژه ها:

Atrial Fibrillation ، Anticoagulants ، Deep Vein Thrombosis ، Pulmonary embolism ، Rivaroxaban