Study design and study population
This was a cross-sectional study conducted at the UZ Brussel, a 721-bed university hospital in Brussels, Belgium. Via the prescription order validation tool, a tool that is used by clinical pharmacists to assess the appropriateness of drug prescriptions with a main focus on high risk medications (HRM), we identified all hospitalized patients who were initiated on or continued with dabigatran, rivaroxaban, apixaban or edoxaban between 1 January 2019 and 31 December 2019.
Patient demographic data (age, gender, weight, body mass index (BMI)), co-medication, co-morbidities (hypertension, heart failure, diabetes mellitus, cerebrovascular disease), most recent laboratory data at the time of the DOAC prescription in the hospital (renal function, liver parameters, anemia, thrombocytopenia), CHA2DS2-VASc and HAS-BLED scores, DOAC type and dosage, bleeding history, surgical procedures during hospital stay, whether or not the DOAC was already initiated before hospital admission, concomitant use of antiplatelet agents, P-glycoprotein and cytochrome P450 3A4 inhibitors and inducers were collected via manual chart review. Creatinine clearance (CrCl) was calculated via the Cockcroft-Gault equation. Drug interactions were assessed according to the 2018 European Heart Rhythm Association (EHRA) guidelines. In case a patient was hospitalized more than once in 2019, only the first prescription of the first admission was taken into account. Data collection was performed by one investigator (M.S.) for consistency.