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Oral anticoagulant dosing, administration, and storage: a cross-sectional survey of Canadian health care providers

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Abstract

Direct oral anticoagulant (DOAC) use is increasing worldwide. However, if not taken or prescribed correctly, DOACs have serious side effects. It is crucial that healthcare providers (HCPs) offer patients accurate information and counselling around DOACs, to optimize safe and effective use. To assess knowledge around oral anticoagulant indication, dosing, storage, and administration, an electronic survey was distributed to HCPs across Canada from June to August 2017, with 18 questions on the practical use of oral anticoagulants. A total of 191 responses were received: 100 from nurse practitioners, 42 from pharmacists, 27 from Hematologists, 5 from Thrombosis specialists, 4 from internists, 9 from residents and fellows, and 2 each from family physicians and registered nurses. Only 51 (26.7%) of the respondents correctly identified all the approved indications for warfarin and 4 DOACs. Only 101 (52.9%) correctly identified that DOACs are not approved for treatment of heparin-induced thrombocytopenia, cerebral sinus venous thrombosis, or mechanical prosthetic valves. 112 (58.6%) felt comfortable or very comfortable prescribing oral anticoagulants. Half of the respondents knew that dabigatran should not be crushed, however only 85 (44.5%) knew that it should not be exposed to moisture. 94 (49%) knew that higher dose rivaroxaban should be taken with food. The results of our study demonstrate that there are important knowledge gaps around HCPs’ practical understanding of oral anticoagulants. Future research should focus on educational interventions to improve HCPs’ knowledge around indications, dosing, storage, and administration, with the goal of enhancing patient safety.

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Funding

SP was a recipient of a CanVECTOR thrombosis fellowship.

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology and Thromboembolism, and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada

    Siavash Piran, Sam Schulman & Menaka Pai

  2. Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Canada

    Mohamed Panju

  3. HHS – General Hospital, Room 1 270A, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada

    Menaka Pai

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  1. Siavash Piran
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  2. Sam Schulman
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  4. Menaka Pai
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Correspondence to Menaka Pai.

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Conflict of interest

Sam Schulman reports receiving consulting fees from Boehringer Ingelheim, Bristol-Myer-Squibb, Bayer and Daichii and grant support from Boehringer Ingelheim, Baxter and Octapharma. Menaka Pai reports receiving consulting fees from Bayer and Novartis. The other authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Piran, S., Schulman, S., Panju, M. et al. Oral anticoagulant dosing, administration, and storage: a cross-sectional survey of Canadian health care providers. J Thromb Thrombolysis 45, 180–185 (2018). https://doi.org/10.1007/s11239-017-1585-y

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  • DOI: https://doi.org/10.1007/s11239-017-1585-y

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