Optimization of direct oral anticoagulant prescribing in primary care: a pharmacotherapeutic review in real-world clinical practice and therapeutic efficiency
4 affiliations
- 1Pharmacy Service, Xarxa Tecla Sanitaria, Social I Docent
- 2Pharmacy Unit, Camp de Tarragona Health Region, Catalan Health Service (CatSalut)
- 3Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona
- 4Clinical Research Unit, Xarxa Tecla Sanitaria, Social I Docent
Abstract
Introduction: Direct oral anticoagulants are among the first-line treatments for stroke prevention in patients with non-valvular atrial fibrillation and for the treatment and secondary prevention of venous thromboembolism. The increasing use of these agents poses challenges related to prescribing appropriateness, clinical safety. This study aims to evaluate the impact of a primary care pharmacist-led intervention on the appropriateness of DOAC prescribing, pharmacotherapeutic efficiency, and clinical outcomes.
Materials and Methods: A retrospective, quasi-experimental before-and-after study was conducted in the healthcare area of Xarxa Santa Tecla (Tarragonès and Baix Penedès, Spain). 791 patients receiving DOAC therapy were included. The intervention comprised multidisciplinary educational activities, individualized pharmacotherapeutic review, and communication of recommendations to prescribers.
Results: The mean age was 78.2 years, and 43.2% of patients had moderate or severe renal impairment. The pharmacotherapeutic review identified 527 patients (66.6%) as candidates for treatment optimization, through a proposed switch from apixaban to dabigatran. The pharmacist intervention was associated with changes in prescribing patterns among newly initiated patients, increasing the use of dabigatran. The economic analysis estimated savings of €75,508.81 from new treatment initiations and €31,288.25 from therapeutic switches, resulting in total savings of €106,797.06 in 2025. The overall bleeding rate remained stable (5.3% in 2024% vs. 5.2% in 2025), with no deterioration in clinical safety. In conclusion, a structured, multidisciplinary, and coordinated primary care pharmacist-led intervention promoted a more efficient use of healthcare resources, while no deterioration in population-level safety indicators was observed. These findings reinforce the role of primary care pharmacists in optimizing anticoagulant therapy.
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BibTeX
@article{guzman2026optimization,
title = {{Optimization of direct oral anticoagulant prescribing in primary care: a pharmacotherapeutic review in real-world clinical practice and therapeutic efficiency}},
author = {Núria Gotanegra Guzmán and Marta Turu Pedrola and Montserrat Viñas-Bastart and Carlos Alonso-Villaverde Lozano and Irene Teixidó Javierre and Mercè Medina Vargas and Pilar Modamio and Josep Maria Guiu-Segura},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1969085},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1969085/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Optimization of direct oral anticoagulant prescribing in primary care: a pharmacotherapeutic review in real-world clinical practice and therapeutic efficiency
AU - Núria Gotanegra Guzmán
AU - Marta Turu Pedrola
AU - Montserrat Viñas-Bastart
AU - Carlos Alonso-Villaverde Lozano
AU - Irene Teixidó Javierre
AU - Mercè Medina Vargas
AU - Pilar Modamio
AU - Josep Maria Guiu-Segura
PY - 2026
DA - 2026/10/14
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1969085
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1969085/full
AB - Introduction: Direct oral anticoagulants are among the first-line treatments for stroke prevention in patients with non-valvular atrial fibrillation and for the treatment and secondary prevention of venous thromboembolism. The increasing use of these agents poses challenges related to prescribing appropriateness, clinical safety. This study aims to evaluate the impact of a primary care pharmacist-led intervention on the appropriateness of DOAC prescribing, pharmacotherapeutic efficiency, and clinical outcomes. Materials and Methods: A retrospective, quasi-experimental before-and-after study was conducted in the healthcare area of Xarxa Santa Tecla (Tarragonès and Baix Penedès, Spain). 791 patients receiving DOAC therapy were included. The intervention comprised multidisciplinary educational activities, individualized pharmacotherapeutic review, and communication of recommendations to prescribers. Results: The mean age was 78.2 years, and 43.2% of patients had moderate or severe renal impairment. The pharmacotherapeutic review identified 527 patients (66.6%) as candidates for treatment optimization, through a proposed switch from apixaban to dabigatran. The pharmacist intervention was associated with changes in prescribing patterns among newly initiated patients, increasing the use of dabigatran. The economic analysis estimated savings of €75,508.81 from new treatment initiations and €31,288.25 from therapeutic switches, resulting in total savings of €106,797.06 in 2025. The overall bleeding rate remained stable (5.3% in 2024% vs. 5.2% in 2025), with no deterioration in clinical safety. In conclusion, a structured, multidisciplinary, and coordinated primary care pharmacist-led intervention promoted a more efficient use of healthcare resources, while no deterioration in population-level safety indicators was observed. These findings reinforce the role of primary care pharmacists in optimizing anticoagulant therapy.
SN - 1663-9812
ER -