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Rational Pharmacotherapy in Cardiology

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Changes in anticoagulant prescription in a general hospital in 2008-2018

https://doi.org/10.20996/1819-6446-2021-08-10

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Abstract

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.

About the Authors

E. B. Kleymenova
General 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 Sciences
Russian Federation

Elena B. Kleymenova

eLibrary  SPIN  2037-7164

Moscow



V. A. Otdelenov
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Vitaly A. Otdelenov

eLibrary  SPIN  8357-5770

Moscow



M. D. Nigmatkulova
General Medical Center of the Bank of Russia
Russian Federation

Maria D. Nigmatkulova

eLibrary  SPIN  2263-3980

Moscow



S. A. Payushchik
General Medical Center of the Bank of Russia
Russian Federation

Svetlana A. Payushchik

eLibrary  SPIN  1367-6633

Moscow



A. A. Chernov
General Medical Center of the Bank of Russia
Russian Federation

Anton A. Chernov

eLibrary  SPIN  5893-5394

Moscow



O. D. Konova
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Olga D. Konova

eLibrary SPIN 7859-0970

Moscow



L. P. Yashina
General Medical Center of the Bank of Russia; Federal Research Center “Computer Science and Control” of the Russian Academy of Sciences
Russian Federation

Liubov P. Yashina

eLibrary SPIN 1910-0484

Moscow



A. M. Cherkashov
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Andrey M. Cherkashov

Moscow



D. A. Sychev
Russian Medical Academy of Continuing Professional Education
Russian Federation

Dmitry A. Sychev

eLibrary SPIN 4525-7556

Moscow



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For citation:


Kleymenova E.B., Otdelenov V.A., Nigmatkulova M.D., Payushchik S.A., Chernov A.A., Konova O.D., Yashina L.P., Cherkashov A.M., Sychev D.A. Changes in anticoagulant prescription in a general hospital in 2008-2018. Rational Pharmacotherapy in Cardiology. 2021;17(4):544-551. (In Russ.) https://doi.org/10.20996/1819-6446-2021-08-10

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)