476 Prescribing of direct oral anticoagulants (DOACs) following a venous thromboembolism: a retrospective audit study

Abstract Introduction Patients with confirmed venous thromboembolism (VTE) are often managed oral anticoagulation. There have been reports of prescribing, particularly dose-related, administration, and dispensing errors associated direct anticoagulants (DOACs), error rate ranging from 5.3% to 37.3% (1). The evidence on the appropriate prescribing DOACs post completion VTE treatment period is lacking as most studies review in patients atrial fibrillation. Aim To evaluate practice for following a discharge large teaching hospitals Trust North England. Methods This retrospective audit covered 1st April 2020 31st March 2021. Electronic medical records adult VTE, admitted Teaching Trust, newly prescribed DOAC were included. Extracted pseudo-anonymised data was analysed descriptively using Microsoft Excel. Creatinine clearance (CrCl) calculated Cockcroft-Gault equation recorded weight. Results initial list diagnosed included 1119 entries, which after cleansing reduced 502 unique meeting eligibility criteria. mean age (±standard deviation) 66±16 years (range 20-99) 52% (n=260) male. Documented diagnosis PE (85%, n=428), DVT (10%, n=49), (4%, n=21), no clear (<1%, n=4). weight CrCl possible calculate 67% (n=334). Out these, 98% (n=328) had doses their level renal function. Treatment duration clearly documented 81% (n=406) 22% (n=108) planned long-term prophylaxis discharge. all patients, 37% (n=187) stopped completing (3 or 6 months), 23% (n=113) continued dose without other comorbidity warranting continue, 21% (n=104) changed recommended dose, 15% (n=76) excluded due missing dying within six months admission, 4% (n=22) fibrillation an dose. Conclusion Our study highlighted that potentially inappropriate use months) prevalent nearly quarter patients. unnecessary continuation can increase risk bleeding events, add medicine expenditure costs, contribute waste healthcare system. Education prescribers primary secondary care management, harnessing pharmacist’s role care, including explicit dosing hospital letters could improve patient safety reduce non-recommended use. main strengths patients’ routine relatively sample size. generalisability analysis limited by accuracy electronic one NHS Trust. References 1. Al Rowily A, Jalal Z, Price MJ, Abutaleb MH, Almodiaemg H, Almmari MA, Paudyal V. Prevalence, contributory factors severity medication direct-acting patients: systematic meta-analysis. Pharmacoepidemiology Prescription. 2022; 78: 623-645.