Risk of blood clots and strokes due to incorrect blood thinner dosage reduced with online dashboard

Developed in 2016 by the U.S. Veterans Health Administration, the online dashboard is designed to highlight and optimize the treatment of patients taking direct oral anticoagulants (DOACs), the most commonly prescribed blood thinners.

Researchers led by Michigan Medicine used the tool to examine more than 120,000 cases in which patients with atrial fibrillation or venous thromboembolism — blood clots in the veins — were treated with DOACs from mid-2015 to 2019 at 123 VA hospitals.

They found that between 6.9 and 8.6 percent of patients received incorrect prescriptions for blood thinners.

The introduction of the electronic DOAC patient management tool resulted in a decrease in off-label dosing by approximately 8%.

The number of blood clots and strokes also decreased everyone Hospital that has implemented the monitoring tool.

The results are published in Journal of the American Heart Association.

“Although DOACs are life-saving medications for patients with common thrombotic conditions, they can also cause serious harm when incorrectly prescribed,” said Geoffrey Barnes, MD, M.Sc., lead author and associate professor of cardiology and internal medicine at UM Medical School.

“Our study not only shows how common off-label dosing of DOACs is, but it also underscores that using this health care tool for DOACs can reduce the rate of inappropriate dosing and subsequent complications such as stroke and blood clots.”

Up to 20% of cases may be incorrect when prescribing direct oral anticoagulants.

The two most commonly prescribed DOACs are rivaroxaban (brand name Xarelto) and apixaban (brand name Eliquis).

The sites that had used the system the longest had a more significant reduction in inappropriate prescribing.

In Michigan, the Michigan Anticoagulation Quality Improvement Initiative, a multicenter coalition of statewide hospitals, has created a similar dashboard using the Epic™ electronic health record.

This system is currently used by five hospitals in the state, including the University of Michigan Health.

“This study represents one of the most comprehensive and impactful evaluations of responsible anticoagulation efforts and demonstrates the reduction in clinical adverse events,” Barnes said.

“Health systems and policy makers should consider investing in anticoagulation stewardship efforts that support pharmacists to review and correct off-label dosing of direct oral anticoagulants for the benefit of millions of patients taking these medications.”