{
  "abstract": "Background: Inappropriate dosing occurs in up to 20% of direct oral anticoagulant (DOAC) prescriptions and is associated with bleeding, hospitalization, and death. Understanding why DOAC dosing errors arise after the initial prescribing period and how clinicians decide to adjust doses may help improve future antithrombotic stewardship efforts. Objectives: This study aimed to describe responses by clinicians to asynchronous electronic health record notifications regarding inappropriate DOAC prescriptions that develop after the initial prescribing period. Methods: As part of a larger randomized trial to improve evidence-based DOAC prescribing, we conducted a manual chart review to assess reasons for inappropriate DOAC prescriptions, clinician response, and reasons for not changing DOAC prescriptions. Results: Most apixaban prescribing errors occurred in patients aged 80 years or older (87.8%). Overall, dose changes occurred after 32.7% of notifications. Notifications to increase the dose of apixaban resulted in fewer dose changes (16.8%) than those to reduce the dose of apixaban (52%), increase the dose of rivaroxaban (43.2%), or decrease the dose of rivaroxaban (43.6%). The original DOAC prescribers were less likely than pharmacists to document a reason for not making a dose change (46.1% vs 90.5%). Renal function, weight, and bleeding-related reasons were commonly cited as reasons not to make a dose change. Conclusion: Various patient factors differentially influenced the likelihood that a clinician would change an inappropriate DOAC prescription. These factors can be used to tailor electronic health record-based notifications to reduce the burden on prescribers while maximizing the impact on patient safety by increasing evidence-based prescribing.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA",
    "Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA; Institute for Health care Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA",
    "Institute for Health care Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA",
    "Center for History, Humanities, Arts, Social Sciences and Ethics in Medicine, University of Michigan, Ann Arbor, Michigan, USA",
    "Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA",
    "Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA",
    "Institute for Health care Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Anish Saraswat"
    },
    {
      "affs": [
        1
      ],
      "name": "Shawna N. Smith"
    },
    {
      "affs": [
        2
      ],
      "name": "Michael P. Dorsch"
    },
    {
      "affs": [
        3
      ],
      "name": "Morris Fabbri"
    },
    {
      "affs": [
        3
      ],
      "name": "Jacob Seagull"
    },
    {
      "affs": [
        4
      ],
      "name": "Seo Youn Choi"
    },
    {
      "affs": [
        5
      ],
      "name": "Michael Lanham"
    },
    {
      "affs": [
        6
      ],
      "name": "Geoffrey D. Barnes"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5agm83kh6kbj6.bib",
  "cited_by": 0,
  "doi": "10.1016/j.rpth.2026.106900",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2475037926035582",
  "id": "5agm83kh6kbj6",
  "issns": [
    "2475-0379"
  ],
  "landing_url": "https://doi.org/10.1016/j.rpth.2026.106900",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "3605|Electronic Health Records Systems"
    ]
  ],
  "openalex": "W7196949510",
  "pdf_url": "https://www.rpthjournal.org/article/S2475-0379(26)03558-2/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-01",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/5agm83kh6kbj6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:44:36Z",
      "native_id": "bca294c9cce14881a6cb3b5c902e8729",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.rpth.2026.106900"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC633-647.5",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Clinical decision support tool evaluation: Correction of direct oral anticoagulant dosing errors by clinical pharmacists and physicians",
  "title_text": "Clinical decision support tool evaluation: Correction of direct oral anticoagulant dosing errors by clinical pharmacists and physicians",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:44:36Z",
  "url": "https://research.draconitic.com/paper/5agm83kh6kbj6",
  "venue": "Research and Practice in Thrombosis and Haemostasis",
  "versions": []
}