Changes in anticoagulant prescription in a general hospital in 2008-2018
Aim. To study the structure of anticoagulant prescription in a general hospital to identify trends and contributing factors.Materials and methods. The study was conducted in an urban general hospital. According to retrospective retrieval from electronic health records, total 17,129 patients received...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Столичная издательская компания
2021-09-01
|
| Series: | Рациональная фармакотерапия в кардиологии |
| Subjects: | |
| Online Access: | https://www.rpcardio.online/jour/article/view/2535 |
| _version_ | 1826949554888507392 |
|---|---|
| author | E. B. Kleymenova V. A. Otdelenov M. D. Nigmatkulova S. A. Payushchik A. A. Chernov O. D. Konova L. P. Yashina A. M. Cherkashov D. A. Sychev |
| author_facet | E. B. Kleymenova V. A. Otdelenov M. D. Nigmatkulova S. A. Payushchik A. A. Chernov O. D. Konova L. P. Yashina A. M. Cherkashov D. A. Sychev |
| author_sort | E. B. Kleymenova |
| collection | DOAJ |
| description | Aim. To study the structure of anticoagulant prescription in a general hospital to identify trends and contributing factors.Materials and methods. The study was conducted in an urban general hospital. According to retrospective retrieval from electronic health records, total 17,129 patients received anticoagulants from 2008 to 2018. Formal appropriateness of oral anticoagulants (OАС) prescriptions for 6,638 patients with atrial fibrillation (AF) was analyzed with CHA2-DS2-VASc score.Results. Appearance of recommendations for the direct oral anticoagulants (DOAC) prescription in clinical guidelines for venous thromboembolism (VTE) and AF management contributed to steady increase in the DOAC taking and decrease in the proportion of warfarin prescription. From 2011 to 2018, the proportion of patients with DOACs prescription increased from 1.7% to 81.5%. The most common indications for anticoagulant were ischemic stroke prevention in AF and VTE with mean rate 75.3% and 23.2%, respectively for the 2011-2018 period. Steady increase in low-molecular-weight heparin (LMWH) prophylactic prescriptions was also shown (Chi-square for linear trend=1340, df=1, p<0.0001). Since 2014, the prescription of LMWH in prophylactic doses increased dramatically, probably related to implementation of computerized decision support system (CDSS) for VTE prevention in the hospital.Conclusion. The study showed that in a general hospital anticoagulants were prescribed in 19% of hospitalized patient. Not only the new clinical recommendations based on the results of the recent studies on anticoagulants efficacy and safety (external factors), but also implementation standard operating protocols and CDSS, providing physicians current information about the relevant clinical recommendations (internal changes), could influence the appropriateness of anticoagulants prescription. |
| first_indexed | 2024-03-08T14:01:39Z |
| format | Article |
| id | doaj.art-f86e479f79e14fd3a1940b4b17266499 |
| institution | Directory Open Access Journal |
| issn | 1819-6446 2225-3653 |
| language | English |
| last_indexed | 2025-02-17T22:15:58Z |
| publishDate | 2021-09-01 |
| publisher | Столичная издательская компания |
| record_format | Article |
| series | Рациональная фармакотерапия в кардиологии |
| spelling | doaj.art-f86e479f79e14fd3a1940b4b172664992024-12-04T11:48:20ZengСтоличная издательская компанияРациональная фармакотерапия в кардиологии1819-64462225-36532021-09-0117454455110.20996/1819-6446-2021-08-101927Changes in anticoagulant prescription in a general hospital in 2008-2018E. B. Kleymenova0V. A. Otdelenov1M. D. Nigmatkulova2S. A. Payushchik3A. A. Chernov4O. D. Konova5L. P. Yashina6A. M. Cherkashov7D. A. Sychev8General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education; Federal Research Center “Computer Science and Control” of the Russian Academy of SciencesGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationGeneral Medical Center of the Bank of RussiaGeneral Medical Center of the Bank of RussiaGeneral Medical Center of the Bank of RussiaGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationGeneral Medical Center of the Bank of Russia; Federal Research Center “Computer Science and Control” of the Russian Academy of SciencesGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationRussian Medical Academy of Continuing Professional EducationAim. To study the structure of anticoagulant prescription in a general hospital to identify trends and contributing factors.Materials and methods. The study was conducted in an urban general hospital. According to retrospective retrieval from electronic health records, total 17,129 patients received anticoagulants from 2008 to 2018. Formal appropriateness of oral anticoagulants (OАС) prescriptions for 6,638 patients with atrial fibrillation (AF) was analyzed with CHA2-DS2-VASc score.Results. Appearance of recommendations for the direct oral anticoagulants (DOAC) prescription in clinical guidelines for venous thromboembolism (VTE) and AF management contributed to steady increase in the DOAC taking and decrease in the proportion of warfarin prescription. From 2011 to 2018, the proportion of patients with DOACs prescription increased from 1.7% to 81.5%. The most common indications for anticoagulant were ischemic stroke prevention in AF and VTE with mean rate 75.3% and 23.2%, respectively for the 2011-2018 period. Steady increase in low-molecular-weight heparin (LMWH) prophylactic prescriptions was also shown (Chi-square for linear trend=1340, df=1, p<0.0001). Since 2014, the prescription of LMWH in prophylactic doses increased dramatically, probably related to implementation of computerized decision support system (CDSS) for VTE prevention in the hospital.Conclusion. The study showed that in a general hospital anticoagulants were prescribed in 19% of hospitalized patient. Not only the new clinical recommendations based on the results of the recent studies on anticoagulants efficacy and safety (external factors), but also implementation standard operating protocols and CDSS, providing physicians current information about the relevant clinical recommendations (internal changes), could influence the appropriateness of anticoagulants prescription.https://www.rpcardio.online/jour/article/view/2535anticoagulantsatrial fibrillationvenous thromboembolismclinical decision support systems |
| spellingShingle | E. B. Kleymenova V. A. Otdelenov M. D. Nigmatkulova S. A. Payushchik A. A. Chernov O. D. Konova L. P. Yashina A. M. Cherkashov D. A. Sychev Changes in anticoagulant prescription in a general hospital in 2008-2018 Рациональная фармакотерапия в кардиологии anticoagulants atrial fibrillation venous thromboembolism clinical decision support systems |
| title | Changes in anticoagulant prescription in a general hospital in 2008-2018 |
| title_full | Changes in anticoagulant prescription in a general hospital in 2008-2018 |
| title_fullStr | Changes in anticoagulant prescription in a general hospital in 2008-2018 |
| title_full_unstemmed | Changes in anticoagulant prescription in a general hospital in 2008-2018 |
| title_short | Changes in anticoagulant prescription in a general hospital in 2008-2018 |
| title_sort | changes in anticoagulant prescription in a general hospital in 2008 2018 |
| topic | anticoagulants atrial fibrillation venous thromboembolism clinical decision support systems |
| url | https://www.rpcardio.online/jour/article/view/2535 |
| work_keys_str_mv | AT ebkleymenova changesinanticoagulantprescriptioninageneralhospitalin20082018 AT vaotdelenov changesinanticoagulantprescriptioninageneralhospitalin20082018 AT mdnigmatkulova changesinanticoagulantprescriptioninageneralhospitalin20082018 AT sapayushchik changesinanticoagulantprescriptioninageneralhospitalin20082018 AT aachernov changesinanticoagulantprescriptioninageneralhospitalin20082018 AT odkonova changesinanticoagulantprescriptioninageneralhospitalin20082018 AT lpyashina changesinanticoagulantprescriptioninageneralhospitalin20082018 AT amcherkashov changesinanticoagulantprescriptioninageneralhospitalin20082018 AT dasychev changesinanticoagulantprescriptioninageneralhospitalin20082018 |