Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study

OBJECTIVE

This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital.

PATIENTS AND METHODS

Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence.

RESULTS

778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications.

CONCLUSIONS

In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

The correlation between severe complications and blood group types in COVID-19 patients; with possible role of T polyagglutination in promoting thrombotic tendencies

<abstract><sec> <title>Introduction</title> <p>Coronavirus disease-19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is still posing detrimental effects on people. An association between contracting COVID-19 and the ABO blood group type has been determined. However, factors that determine the severity of COVID-19 are not yet fully understood. Thus, the current study aimed to investigate whether the ABO blood group type has a role in the severity of complications due to COVID-19.</p> </sec><sec> <title>Materials and methods</title> <p>Eighty-Six ICU-admitted COVID-19 patients and 80 matched-healthy controls were recruited in the study from Baish general hospital, Saudi Arabia. ABO blood grouping, complete blood count (CBC), CBC-derived inflammatory markers, coagulation profile, D-Dimer and anti-T antigen were reported.</p> </sec><sec> <title>Results</title> <p>Our data showed that patients with blood groups O and B are more protective against severe complications from COVID-19, as compared to patients with blood groups A and AB. This could be partially attributed to the presence of anti-T in blood group A individuals, compared to non-blood group A.</p> </sec><sec> <title>Conclusion</title> <p>The current study reports an association between the ABO blood group and the susceptibility to severe complications from COVID-19, with a possible role of anti-T in driving the mechanism of the thrombotic tendency, as it was also correlated with an elevation in D-dimer levels.</p> </sec></abstract>