Study design and study population
This was a cross-sectional study conducted at the UZ Brussel, a 721-bed
university hospital in Brussels, Belgium. Via the prescription order
validation tool, a tool that is used by clinical pharmacists to assess
the appropriateness of drug prescriptions with a main focus on high risk
medications (HRM), we identified all hospitalized patients who were
initiated on or continued with dabigatran, rivaroxaban, apixaban or
edoxaban between 1 January 2019 and 31 December 2019.
Patient demographic data (age, gender, weight, body mass index (BMI)),
co-medication, co-morbidities (hypertension, heart failure, diabetes
mellitus, cerebrovascular disease), most recent laboratory data at the
time of the DOAC prescription in the hospital (renal function, liver
parameters, anemia, thrombocytopenia),
CHA2DS2-VASc and HAS-BLED scores, DOAC
type and dosage, bleeding history, surgical procedures during hospital
stay, whether or not the DOAC was already initiated before hospital
admission, concomitant use of antiplatelet agents, P-glycoprotein and
cytochrome P450 3A4 inhibitors and inducers were collected via manual
chart review. Creatinine clearance (CrCl) was calculated via the
Cockcroft-Gault equation. Drug interactions were assessed according to
the 2018 European Heart Rhythm Association (EHRA) guidelines. In case a
patient was hospitalized more than once in 2019, only the first
prescription of the first admission was taken into account. Data
collection was performed by one investigator (M.S.) for consistency.