Abstract 11666: Real-life Dabigatran Patient Selection: Change Over Time and Compared to the RE-LY Study Population

Abstract

Background Dabigatran 150 mg twice daily has better stroke prevention efficacy compared to warfarin, with similar rates of major bleeding in patients with atrial fibrillation. Dabigatran is renally eliminated; in order to minimize the risk of hemorrhage, patients with similar renal function to those studied should be prescribed this medication in real-life practice.

Objectives The primary objective was to characterize the population prescribed dabigatran at our institution and compare to the RE-LY patient population. Secondary objectives were to determine prescribing pattern changes following an educational intervention, and determine if patients were prescribed dabigatran inappropriately.

Methods and Results Patients prescribed dabigatran in a three hospital health-system were identified and patient-specific data were collected. Using descriptive statistics, these patient characteristics were compared to the patients in the RE-LY study. An educational intervention was presented to prescribers highlighting the differences in the patient populations. In addition, creatinine clearance was made available in the laboratory section of the medical record. Post-intervention, additional patients prescribed dabigatran were reviewed and their characteristics compared to the RE-LY patient population and the pre-intervention population. See results in the table below. Overall use of dabigatran declined by approximately 40%, from 18/1000 patient days to 11/1000. Pre-intervention, there were two dabigatran dosing errors based on the degree of renal dysfunction; following the educational intervention, there were no dosing errors identified.

Conclusion Those prescribed dabigatran appear similar to those studied in RE-LY, except for the higher use in patients with CrCl < 30 mL/min. These data suggest the educational intervention decreased both the inappropriate dose selection of dabigatran and its use in patients with CrCl < 30 mL/min.