Skip to content
DraconiticResearch
Search Sources API
197,768 studies31 sourcesUpdated 58 min ago
Peer-reviewedCC BYResearch and Practice in Thrombosis and Haemostasis

Clinical decision support tool evaluation: Correction of direct oral anticoagulant dosing errors by clinical pharmacists and physicians

  • Anish Saraswat1
  • Shawna N. Smith2
  • Michael P. Dorsch3
  • Morris Fabbri4
  • Jacob Seagull4
  • Seo Youn Choi5
  • Michael Lanham6
  • Geoffrey D. Barnes7
7 affiliations
  1. 1Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Department 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
  3. 3Institute 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
  4. 4Center for History, Humanities, Arts, Social Sciences and Ethics in Medicine, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  6. 6Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
  7. 7Institute 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
Read full textPDFDOICite

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.

Related

  1. Reconfiguring clinical pharmacists’ roles under China’s DRG payment system: perspectives from clinical pharmacists and physicians in multidisciplinary teams
    Juan Fu, Xiang Gao, Qingran Sun +2
    Frontiers in Public HealthPeer-reviewedCC BY 4.0Full textPharmacology & toxicologyCrossrefEurope PMCPMC
  2. Factors affecting task shifting/sharing from physicians to pharmacists in cancer chemotherapy in Japan: A qualitative study
    Keiko Ikuta, Atsushi Yonezawa, Hiroshi Okada +6
    PLOS OnePeer-reviewedCC BY 4.0OncologyPLOS
  3. Evaluation of clinical interventions made by pharmacists, doctors and nurses in a hospital post-discharge telephone service: a retrospective cohort study
    Kum Chuan Leong, Darshana Meanger, Philip Wu +4
    International Journal of Clinical PharmacyPeer-reviewedCC BY 4.0Full textGeneral medicinePMC
  4. Evaluation of Resident Physicians Inpatient Clinical Performance Using a DRG-Based Weighted TOPSIS-RSR Model: A Single-Centre Pilot Study
    Duan Xiaoli, Wen Guohong
    Advances in Medical Education and PracticePeer-reviewedCC BY-NC 4.0Full textEpidemiology & public healthPMCEurope PMC
  5. Navigating the Role of Clinical Pharmacists in Integrative Oncology Care Teams: Time to Create Higher Training and Practice Standards
    Eran Ben‐Arye, Sunita Vohra, Noah Samuels +1
    Clinical Pharmacology and TherapeuticsPeer-reviewedCC BY-NC 4.0Full textGeneral medicinePMC

Cite

BibTeXRIS
BibTeX
@article{saraswat2026clinical,
  title = {{Clinical decision support tool evaluation: Correction of direct oral anticoagulant dosing errors by clinical pharmacists and physicians}},
  author = {Anish Saraswat and Shawna N. Smith and Michael P. Dorsch and Morris Fabbri and Jacob Seagull and Seo Youn Choi and Michael Lanham and Geoffrey D. Barnes},
  journal = {Research and Practice in Thrombosis and Haemostasis},
  year = {2026},
  month = aug,
  doi = {10.1016/j.rpth.2026.106900},
  url = {https://doi.org/10.1016/j.rpth.2026.106900},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Clinical decision support tool evaluation: Correction of direct oral anticoagulant dosing errors by clinical pharmacists and physicians
AU  - Anish Saraswat
AU  - Shawna N. Smith
AU  - Michael P. Dorsch
AU  - Morris Fabbri
AU  - Jacob Seagull
AU  - Seo Youn Choi
AU  - Michael Lanham
AU  - Geoffrey D. Barnes
PY  - 2026
DA  - 2026/08/01
JO  - Research and Practice in Thrombosis and Haemostasis
DO  - 10.1016/j.rpth.2026.106900
UR  - https://doi.org/10.1016/j.rpth.2026.106900
AB  - 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.
SN  - 2475-0379
ER  -