DOAC starter packs being prescribed in adults without acute VTE diagnosis

A recent study has found that many patients on direct oral anticoagulant (DOAC) starter packs had no diagnosis of acute venous thromboembolism (VTE), raising fears regarding inappropriate prescribing and potential complications.

“The 30-day DOAC starter pack has simplified the treatment of acute VTEs, but it is not appropriate for use in patients with other indications for anticoagulation,” the investigators said.

This retrospective analysis was carried out using national outpatient pharmacy claims data between 1 January 2015 and 31 December 2018. Patients aged >18 years with continuous insurance enrolment at least 12 months prior to and 1 month following a DOAC starter pack prescription during the study period were included.

Inappropriate prescription of DOAC starter packs was defined as a prescription without a VTE diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days.

A total of 3,711 DOAC starter pack prescription fills were identified; this represented 3,634 unique patients (mean age, 62.8 years; 50.4 percent females). Of these, 770 (20.7 percent) were deemed potentially inappropriate.

Patients with an inappropriate prescription fill were more likely to be older than those with appropriate fills (64.7 vs 62.4 years; p<0.001). No significant difference was observed in the race or geographic location between patients with inappropriate and appropriate prescriptions.

“Future studies are needed to identify factors associated with inappropriate direct oral anticoagulant starter pack prescription and evaluate efforts to reduce this practice,” the investigators said.