A direct oral anticoagulant (DOAC) population-based management tool (PMT) efficiently revealed potential interactions between DOACs and nonsteroidal anti-inflammatory drugs (NSAIDs), allowing clinical pharmacy specialists (CPS) to intervene when necessary, according to the results of a study presented at the Thrombosis & Hemostasis Summit of North America (THSNA) 2020 Virtual Conference.

Liem T. Nguyen, PharmD, BCPS, and colleagues at the Salisbury Veterans Affairs Health Care System (SVAHCS), Salisbury, North Carolina, conducted a retrospective chart review after the SVAHCS implemented use of a DOAC PMT in October 2018.

“The PMT can be used to alert [CPSs] of potentially interacting medications, allowing a CPS to quickly and efficiently address any potential concerns and eliminating the need for routinely scheduled appointments,” wrote the authors.

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The primary objective of the study was to identify the potential for CPS intervention based on alerts from the DOAC PMT in patients receiving a DOAC in conjunction with an NSAID, which can potentially increase bleeding risk. The secondary objective was to identify the causes of concurrent DOAC and NSAID prescriptions without gastrointestinal (GI) protection.

The team used the DOAC PMT to identify 3400 patients receiving DOAC therapy from February to March 2019. Of the cohort, 150 patients (4.4%) had active or recently expired prescriptions for an NSAID.

Among the 150 patients with potential interactions, 57 patients (38%) were not receiving GI protective therapy. It was determined that 19 patients (13%) did not require an intervention, whereas 38 patients (23%) needed CPS intervention.

The reasons behind the DOAC/NSAID concurrent prescriptions included: 2 cases (5%) in which the DOAC order was processed and filled without a prior authorization drug request (PADR), meaning the CPS did not receive an opportunity to review the order nor to provide patient education and follow up; 10 cases (26%) included the PADR but the interaction was not addressed by a CPS; 13 cases (34%) in which the CPS addressed the interaction but the provider had not yet implemented the recommendation; and 13 cases (34%) in which the NSAID was prescribed after the PADR, but the interaction was not addressed by a CPS.

The investigators highlighted the limitations of the study as potential over-the-counter NSAID use and undocumented care provided, nonadherence to medication directions, out-of-date medication lists, and grey areas in clinical judgment.

“The majority of the patients identified did not require a clinical intervention; many patients on concurrent DOAC/NSAID therapy are managed appropriately,” wrote the authors.

“The DOAC PMT can be used to efficiently address any potential concerns regarding DOAC/NSAID interactions. Providers should continue to assess the risks against the potential benefits of NSAID use in each clinical situation,” concluded the investigators.


Nguyen LT, Edwards RF, Folstad JE, Mobley JD, Almond JW. Evaluation of a population-based management tool in identifying potential interactions between direct oral anticoagulants and non-steroidal anti-inflammatory drugs at a Veterans Affairs health care system. Abstract presented at: THSNA 2020 Thrombosis & Hemostasis Summit of North America; October 27-30, 2020. Abstract 7.