국내 대학병원에서의 Rivaroxaban 처방 적정성 평가

Abstract

Rivaroxaban is useful advantageous because it does not require routine lab monitoring,such as the PT/INR of warfarin. However, dose adjustments are recommended for patients with renalfailure. Also, deep vein thrombosis and pulmonary embolism are required for the initial treatment,and the initial dose is 15 mg twice daily for 3 weeks. Furthermore, the Health Insurance Review &Assessment Service (HIRA) has regulated the clinical use of rivaroxaban for certain indications. Theserestrictions should be reviewed before prescribing rivaroxaban. The aim of this study was to investigate and evaluate the patterns of rivaroxaban usage, and tomonitor its administration according to the recommended dose and the standards of the NationalHealth Insurance in Ulsan University Hospital (UUH). A retrospective analysis was performed by using an electronic medical record database. This study was conducted through a retrospective medical chart review of 145 patients who received rivaroxabanfrom October 1, 2013 to February 28, 2014 at UUH. The evaluation of rivaroxaban use was based on the standards of the American Society of Health-System Pharmacists, which were modified to fit this study. The results are as follows. First, there were 75 (52%) patients who were 65 years of age or older,consisting of 17 male patients and 58 female patients. Second, there were 7 (5%) patients with moderate renal failure, in which two of them showed nonvalvularatrial filbrillation and required a dosage reduction of rivaroxaban. Third, 137 of 145 patients were consistent with indication criteria (95%), and 86 patients did notreceive National Health Insurance coverage. In this case, 40% of the DUE criteria rate was suitablefor administration. Also, 33 patients suffering from an embolism (DVT or PE) were recommended forthe initial treatment, which is 15 mg twice daily for 3 weeks. However, 26 of those patients received apotentially inappropriate initial treatment, while 7 patients received an appropriate initial treatment. Finally, 4 cases reported to have adverse events. One of the reports consisted of skin rash due to anadverse drug reaction to rivaroxaban. The other three adverse events were unlikely due to rivaroxaban. The justification of use based on indications showed a high rate (95%) of its appropriateness, whilethe justification of use in the other three criteria showed a lower than average rate (37%). One case ofa skin rash was possibly related to an adverse reaction to rivaroxaban. Furthermore, the results of this study show that additional research is warranted on other new oralanticoagulants.