Ole Martin Søbakk has successfully defended his master’s thesis.
Title:
Use of direct-acting oral anticoagulants in elderly multidose patients - A study of interactions, fall-related drugs and anticholinergic drugs
Supervisors:
- Anne Katrine Eek, Regional Medicines Information Center (RELIS)
- Anette Vik Jøsendal (National Center for e-Health Research)
- Anne Gerd Granås (University of Oslo)
External examiner:
Marianne W. Munkerud
Internal examiner:
Ida Robertsen
Please join everyone at PharmaSafe in congratulating Ole Martin on completing a high-quality thesis in social pharmacy and wishing him the best of luck with his career in pharmacy!
Abstract
Introduction: In Norway, non-vitamin K-dependent oral anticoagulants (NOACs) became available in 2012. The four drugs dabigatran, rivaroxaban, apixaban and edoxaban have at large replaced warfarin. There is still limited knowledge on how these drugs are prescribed and whether physicians take other concurrent drug use into account when prescribing.
Aims: The aim of this study is to examine the prescribing of NOACs in a sample of patients receiving multidose drug dispensing (MDD), including potential inappropriate prescribing in form of drug interactions, and concomitant use of either fall risk increasing drugs (FRIDs) or anticholinergic drugs (ADs).
Method: A cross-sectional study of patients receiving MDD in 2019. The dataset is comprised of medication lists of 87 327 patients. We used the Norwegian Medicines Agency online tool to investigate the prevalence of drug interactions with NOACs. We used lists from the Swedish National Board of Health and Welfare to investigate concomitant use with NOACs and FRIDs, and the CRIDECO Anticholinergic Load Scale (CALS) to investigate concomitant use with NOACs and ADs, as well as calculate the anticholinergic burden for patients using NOACs. All analysis is done in the data software Stata 17.0.
Results: Of the 87 327 patients included, 13 670 (16%) used NOAC. Of there, 10 370 received home care services, 2 648 were in nursing homes and 652 were home-dwelling. They were prescribed on average 11,2 medications. Drug-drug interactions with NOACs were found in 3 711 (27,2%) of the patients, of which 34 (0,9%) were severe interactions that should be avoided. Almost all patients (96,7%) used at least one FRID, and about half (47,2%) had an anticholinergic score greater than or equal to 3.
Conclusion: The use of NOACs is higher in patients receiving MDD than the general population. Concomitant use with ADs and/or FRIDs was high, which increases the risk of falling and serious adverse drug reactions.