PSA Advisories

Identifying Patient Harm from Direct Oral Anticoagulants

Direct oral anticoagulants (DOACs), a newer class of oral anticoagulants, have been promoted as a safer and more effective option than warfarin. A query of the Pennsylvania Patient Safety Reporting System (PA-PSRS) database for events involving DOACs that occurred from January 2011 through August 2017 revealed 1,811 reported events, including 265 that resulted in patient harm. The data from these reports were categorized into two groups: harmful events (i.e., adverse drug events) (14.6%, n = 265) and medication errors without harm (85.4%, n = 1,546). Hemorrhage was the most frequently reported adverse event (70.2%, n = 186 of 265). Almost 40% (38.5%, n = 102 of 265) of harmful events occurred to patients who were 80 years or older. Duplicate therapy (33.3%, n = 515 of 1,546) was the most frequently reported type of error without harm. Employing standard protocols to guide therapy, reviewing baseline patient information, including patient weight (in metric units) and laboratory test results such as renal and liver function, and considering the therapeutic indication can aid selection of an appropriate anticoagulant medication for patients.

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