Please use this identifier to cite or link to this item: http://cmuir.cmu.ac.th/jspui/handle/6653943832/70976
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dc.contributor.authorPhannita Wattanaruengchaien_US
dc.contributor.authorSurakit Nathisuwanen_US
dc.contributor.authorWipharak Rattanavipanonen_US
dc.contributor.authorSuvatna Chulavatnatolen_US
dc.contributor.authorJunporn Kongwatcharapongen_US
dc.contributor.authorPhatcharin Mitsuntisuken_US
dc.contributor.authorThanaputt Chaiyasothien_US
dc.contributor.authorDuangkamon Kritsanapipaten_US
dc.contributor.authorArintaya Phrommintikulen_US
dc.contributor.authorNathorn Chaiyakunapruken_US
dc.contributor.authorKhanchit Likittanasombaten_US
dc.contributor.authorGregory Y.H. Lipen_US
dc.date.accessioned2020-10-14T08:45:53Z-
dc.date.available2020-10-14T08:45:53Z-
dc.date.issued2020-01-01en_US
dc.identifier.issn13652125en_US
dc.identifier.issn03065251en_US
dc.identifier.other2-s2.0-85090448785en_US
dc.identifier.other10.1111/bcp.14535en_US
dc.identifier.urihttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85090448785&origin=inwarden_US
dc.identifier.urihttp://cmuir.cmu.ac.th/jspui/handle/6653943832/70976-
dc.description.abstract© 2020 The British Pharmacological Society Aims: This study aimed to evaluate the prescriber compliance to the approved labels of direct oral anticoagulants (DOACs) and impact of appropriateness of dosing on clinical outcomes. Methods: A retrospective study was conducted using simple-stratified random sampling of adult patients receiving ≥6 months of DOACs for various indications during 2013–2017 in 10 tertiary care hospitals. Patients were classified into 3 dosing groups including approved dose, underdosing and overdosing based on the Thai Food and Drug Administration-approved labels. Cox proportional hazard models were used to evaluate the impact of different dosings on thromboembolic and bleeding events. Results: From 1200 patients included in the data analysis, prescribing of DOACs was consistent with the approved indications in 1130 cases (94.2%) while 70 patients (5.8%) received DOACs despite having contraindications or with off-label usage. Among 1026 cases of dosing evaluation cohort, 688 patients (67.1%) received approved doses. There were 227 (21.9%) and 110 (10.7%) cases of underdosing and overdosing, respectively. Multivariate analysis showed that underdosing was associated with an increased risk of thromboembolism 3.023 (95% confidence interval [CI]: 1.291–7.080; P =.011) while overdosing was associated with an increased risk of bleeding requiring hospitalization (adjusted hazard ratio, 3.045; 95% CI, 1.501–6.178; P =.002) and Bleeding Academic Research Consortium type 2 or more (adjusted hazard ratio, 2.196; 95% CI, 1.083–4.452; P =.029). Conclusion: Prescribers’ compliance to approved indications were high. However, 1/3 of DOAC prescriptions were inconsistent with approved dosing. Dosing deviation was associated with an increase in adverse clinical outcomes.en_US
dc.subjectMedicineen_US
dc.subjectPharmacology, Toxicology and Pharmaceuticsen_US
dc.titlePrescriber compliance to direct oral anticoagulant labels and impact on outcomes in Thailanden_US
dc.typeJournalen_US
article.title.sourcetitleBritish Journal of Clinical Pharmacologyen_US
article.stream.affiliationsThammasat University Hospitalen_US
article.stream.affiliationsLiverpool Heart and Chest Hospitalen_US
article.stream.affiliationsThe University of Utahen_US
article.stream.affiliationsPolice General Hospitalen_US
article.stream.affiliationsFaculty of Medicine, Ramathibodi Hospital, Mahidol Universityen_US
article.stream.affiliationsMahidol Universityen_US
article.stream.affiliationsFaculty of Medicine, Siriraj Hospital, Mahidol Universityen_US
article.stream.affiliationsChiang Mai Universityen_US
article.stream.affiliationsSrinakharinwirot Universityen_US
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