Oral Anticoagulant Dosing, Administration, and Storage: A Cross-Sectional Survey of Canadian Health Care Providers
Bibliographic record
Abstract
Abstract Background: Direct oral anticoagulant (DOAC) use is increasing worldwide. However, if not taken or prescribed correctly, DOACs have serious side effects. It is crucial that healthcare providers (HCPs) provide patients with accurate information and counselling around DOACs, to optimize safe and effective use. Aims: To assess HCPs' knowledge about oral anticoagulant indication, dosing, storage, and administration. Methods: An electronic survey was distributed to HCPs across Canada from June to July 2017, with 18 questions on oral anticoagulant practical use. Results: A total of 73 responses were received: 27 (37%) from Hematologists, 4 (5.4%) from Thrombosis Medicine specialists, 17 (23.3%) from nurse practitioners, 17 (23.3%) from pharmacists, and 8 (11%) from residents and fellows in Hematology training programs across Canada. The median duration of practice was 7 years (range 0.5 to 41). The majority of respondents (64 of 73; 88%) worked in the outpatient setting. Only 18 (25%) of the respondents correctly identified all the approved indications for warfarin and 4 DOACs including dabigatran, rivaroxaban, apixaban, and edoxaban. Most of the respondents (54 of 73; 74%) correctly identified that DOACs are not approved for treatment of heparin induced thrombocytopenia, cerebral sinus venous thrombosis, or mechanical prosthetic valves. However, 11 (15%) cited one or more of the above indications incorrectly; 7 of 11 (9.5%) alarmingly chose mechanical prosthetic valves as an indication for DOACs. Most of the respondents (51 of 73; 70%) felt comfortable or very comfortable prescribing oral anticoagulants. When counselling patients, 69 (95%) discussed the indication and bleeding side effects, 62 (85%) discussed when/how to take the drug, and only 37 (51%) discussed adherence and administration strategies. About two thirds of the respondents (63%) knew that dabigatran should not be crushed, however only 38 (52%) knew that it should not be exposed to moisture. Forty-five of the respondents (62%) knew that higher dose rivaroxaban should be taken with food. While 45 (62%) correctly adjusted the dose of apixaban based on age, only 35 (48%) did the same for dabigatran. 80%, 77%, 70%, and 45% correctly adjusted rivaroxaban, apixaban, dabigatran, and edoxaban, respectively for renal function. Conclusions: Although the majority of respondents expressed comfort with oral anticoagulants, there are important knowledge gaps around HCPs' practical understanding of oral anticoagulants, particularly in correctly identifying approved indications and counselling patients on adherence and administration. These knowledge gaps (e.g., inappropriate DOAC use in patients with mechanical valves) may lead to significant patient harm in the form of thrombosis or bleeding. Future research should focus on educational interventions to improve HCPs' knowledge around oral anticoagulants, with the goal of enhancing patient safety. Figure 1. What do health care providers counsel patients about when prescribing oral anticoagulants? Download : Download high-res image (82KB) Download : Download full-size image Figure . Disclosures No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".