Oberoi Consulting

How many of your DOAC patients are on the right dose?

Atrial Fibrillation is the most common heart rhythm disorder in primary care and increases the risk of stroke considerably in most sufferers.

DOACsIn order to reduce this risk, high risk AF patients should be anticoagulated either with a VKA (i.e. Warfarin) or with a Direct Oral Anticoagulant (DOAC).

Whilst Warfarin has been used for many years, to successfully prevent strokes in those with AF, DOACs (Apixaban, Edoxaban, Rivaroxaban and Dagibitran) are now equally effective and safe alternatives.

DOACs are used at fixed doses and require reduced monitoring of blood levels in comparison to VKAs/Warfarin.

Whilst DOACs have reduced monitoring requirements in comparison to their VKA counterparts it is important to understand that the use of DOACs still comes with elements which need to measured.

Although DOACs may not require regular monitoring of clotting parameters like VKAs, dosing of DOACs depend on accurate renal monitoring every 6 months to annually, weight measurement etc. and therefore certain changes to these measurements can result in important dosage adjustments and modification.

Serum Creatinine, Creatinine Clearance, Age, Weight, concurrent use of P-gp inhibitors are all factors which must be assessed and regularly monitored when a patient is prescribed and managed on a DOAC.


Key Findings from Audits

Early audit outputs, from a combined list size of 87,921 patients, from the Oberoi SPAF & Case Finding service show over 25% of patients on DOAC therapy don’t have all of the measurements required for dosing recorded on the clinical system; these being Weight, Cr/CL and Serum Creatinine.

These are key monitoring parameters which can affect dosing regimens of DOACs and therefore should be recorded in order to assess if the dose is appropriate for patients prescribed a DOAC.

69.7% of DOAC patients did have Weight, Cr/Cl and Serum Creatinine readings recorded at least once and out of these 23.6% needed a review of their DOAC dose according to SpC dosing guides.

Practices are now able to focus efforts on perfecting anticoagulation treatment more efficiently than before through the Oberoi SPAF & Case Finding Service.

To find out more, please call 01332 224 251 or email admin@oberoi-consulting.com

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