Background Direct oral anticoagulants (DOACs) require different follow-up than vitamin K inhibitors. DOACs dose adjustment depends on indication, age, renal function and weight, which could made dosage errors easier.

Purpose To analyse the use of DOACs and their prescription profile in the indications funded by the national health system.

Material and methods The retrospective observational study considered patients admitted in February 2017 with a prescription of some DOACs included in the Hospital Pharmacotherapeutic Guide (apixaban, dabigatran and rivaroxaban). Data sources: electronic medical records, primary care prescription and hospital electronic prescription. Data collected: age, sex, DOAC, previous anticoagulant and reason for change, dose, schedule, indication and creatinine level at admission and discharge.

Results Thirty-five patients were included, of whom 51.4% were female; median age was 82 (IQR 78.75–86.25) years. Sixteen (47.1%) patients had previously received acenocoumarol, owing to overdose or haemorrhage (five patients), stroke (four), poor control of INR (four) and patient preference (three). Thirty-six DOACs were prescribed: dabigatran in four (11.1%) patients, rivaroxaban in eight (22.2%) and apixaban in 24 (66.7%).

Two (5.7%) patients were treated with rivaroxaban to prevent thromboembolism in knee replacement with 10 mg every 24 hours for 34 and 49 days, respectively (2 weeks is the optimal duration).

In 33 (94.3%) patients, the indication was prevention of stroke and embolism in patients with non-valvular atrial fibrillation with some risk factor. Twenty-four patients were admitted with DOACs: four with dabigatran, one of them (25%) underdosed; six with rivaroxaban, two of them (33.3%) underdosed; 14 patients with apixaban, five (35.7%) underdosed; and three (21.4%) impossible to evaluate because the weight was unknown. During the admission 10 treatments were initiated, four suspended and three patients died. Three patients were discharged with dabigatran, one of them (33.3%) underdosed; three with rivaroxaban, two of them (66.7%) underdosed; and 23 with apixaban, nine of them (39.1%) underdosed; and three with weight undocumented.

Conclusion DOACs require less follow-up than classic anticoagulants, however it is necessary that the dose adjustment is optimised, the control of treatment length and the promotion of the use of these drugs for their approval indications to ensure their safety and efficacy.

References and/or acknowledgements No conflict of interest.