4CPS-135 Pharmaceutical interventions on direct oral anticoagulants in emergency department

<h3>Background and Importance</h3> Pharmacists play an important role on Emergency department (ED) safety promotion. Reviewing high-risk medication prescriptions, such as direct Oral Anticoagulation (DOAC) is a high priority strategy. <h3>Aim and Objectives</h3> To analyse number and type of pharmaceutical interventions related to DOACs at ED and to evaluate degree of acceptance of pharmacist recommendations by physicians. <h3>Material and Methods</h3> Prospective, longitudinal, observational study was conducted from June-September 2024. ED pharmacist reviewed DOACs prescriptions daily (Monday to Friday). DOAC’s review was collected in pharmacy electronically prescription programme and further analysed. All ED interventions were orally or electronically communicated to prescribers. Data collected were: patient’s age and sex, at home prescription, ED prescription, intervention required and degree of acceptance by physicians. <h3>Results</h3> 153 patients with DOAC prescription on ED were reviewed. 51.6% (n=79) were men, median age was 82 years (range 42–97). DOACs prescribed: apixaban 60.1% (n=92), dabigatran 9.2% (n=14), edoxaban 18.9% (n=29), rivaroxaban 11.8% (n=18). 18.9% (n=29) of patients required pharmaceutical intervention related with DOACs prescription. Interventions were: renal function adjustment counselling 62.1% (n=18), dose adjustment due to weight and renal function 6.9% (n=2), dose adjustment performed but not necessary 10.3% (n=3), contraindication of DOACs due to limit renal function 6.9% (n=2), patient with active bleeding 3.5% (n=1), patient with home suspended DOAC but prescribed in ED 6.9%(n=2), nasogastric tube contraindication 3.5(n=1): dabigatran was being opened by the nurses and a change of DOAC was required. Related to degree of acceptance of interventions: 62.1% (n=18) were accepted by physicians, 24.1% (n=7) were non-accepted, and it 13.8% (n=4) was not possible to asses due to length of stay &lt;24h. <h3>Conclusion and Relevance</h3> In our cohort, 18.9% of patients had an incorrect DOAC prescription during their ED stay. The most frequent intervention is related to dosing: each DOAC has different recommendations related to dose adjustment and probably it leads to more mistakes. Most of our interventions were accepted by physicians, which reinforces that pharmacist should be part of a multidisciplinary team and can contribute improving patients’ safety. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest