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953: EVALUATION OF DIRECT ORAL ANTICOAGULANTS IN THE PERIOPERATIVE SETTING AT A 591-BED TEACHING HOSPITAL

Introduction/Hypothesis: Direct oral anticoagulants (DOACs) are often preferred over warfarin by providers and patients due to nonessential monitoring, fewer drug-drug and drug-food interactions, and more predictable pharmacokinetics. However, there is vague guidance by the manufacturers, as well as clinical guidelines, on how to manage this medication class in the perioperative setting, during which the risks for bleeding and thrombosis are increased. This study will evaluate the prescribing patterns of DOACs by procedural services in a 591-bed teaching hospital in Long Island, NY. Methods: This was a single-center, retrospective chart review of patients admitted under procedural services at NYU-Winthrop Hospital. Patients were included if they were at least 18 years and ordered a DOAC between 7/2018-12/2018. Patients were excluded if DOACs were ordered for non-FDA approved indications or never administered. The electronic medical records were used to collect patient demographic information, indication for DOAC use, DOAC ordered and dose, time (in days) held perioperatively, and bleeding/thrombosis events. Primary outcomes were rate of prescribing in accordance with package insert dosing guidelines and total time DOAC was held. Results: There were 336 orders for DOACs from procedural services during our study timeframe. A sampling of 107 orders were analyzed and 90 were included. Mean age was 77 years (range 34-95) and 56% were male. Apixaban accounted for 62% of DOAC orders and rivaroxaban and dabigatran accounted for 29% and 9%, respectively. Twenty-two percent of DOAC orders were incorrect. Seventy percent of the incorrect orders were due to apixaban dosed 2.5 mg twice daily for atrial fibrillation in patients who did not meet the criteria for reduced dosing. In patients who had procedures, DOACs were held for a mean duration of 5.5 days (range 0-11). Conclusions: DOAC use is complicated by dosing variations based on indication and patientspecific factors, such as age, weight, and renal function. Education is warranted on accurate dosing of DOACs overall, but especially when dose reduction is indicated for apixaban in atrial fibrillation. Additionally, DOACs are being held too long in the perioperative setting, increasing the risk of thrombosis.