{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T19:55:20Z","timestamp":1774468520120,"version":"3.50.1"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>DOACs are widely used for stroke prevention in non-valvular atrial fibrillation and treatment of thromboembolism, but gaps in their management can lead to adverse outcomes. In outpatient, underserved clinics, challenges such as inappropriate dosing, lack of monitoring, and improper drug combinations may be more pronounced, necessitating evaluation to optimize patient care and reduce risks. This study assessed the appropriateness of DOAC use and dosing per FDA guidelines, considering renal function, hepatic function, and drug\u2013drug interactions. Secondary objectives focused on evaluating inappropriate aspirin use alongside DOACs. This was a single-center retrospective cohort study. The study was conducted at Texas A&amp;M Health Family Care Clinic (12\/24\/2022\u201312\/24\/2023). Older than 18\u00a0years of age and had active prescription of DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban). A total of 125 DOAC patients were included. Inappropriate dosing based on renal function occurred in 16% of cases. DOAC use was unsuitable in two patients with severe hepatic impairment. Major drug interactions resulted in two instances of inappropriate DOAC use. Additionally, about 61% of aspirin usage involved inappropriate combinations with DOACs, as shown in Fig.\u00a01. The study\u2019s findings indicate that anticoagulation management in our ambulatory care setting has the potential for further optimization.<\/jats:p>","DOI":"10.1038\/s41598-025-07712-0","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T22:59:28Z","timestamp":1751410768000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of gaps in direct oral anticoagulants (DOACs) management in an outpatient underserved clinic: a cross-sectional study"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5701-0216","authenticated-orcid":false,"given":"Bader M.","family":"Alghamdi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9851-4151","authenticated-orcid":false,"given":"Sara L.","family":"Rogers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"issue":"1","key":"7712_CR1","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1038\/clpt.2012.197","volume":"93","author":"S Mantha","year":"2013","unstructured":"Mantha, S., Cabral, K. & Ansell, J. New avenues for anticoagulation in atrial fibrillation. Clin. Pharmacol. Ther. 93(1), 68\u201377 (2013).","journal-title":"Clin. Pharmacol. Ther."},{"issue":"13","key":"7712_CR2","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1001\/jama.2021.13844","volume":"326","author":"DS Budnitz","year":"2021","unstructured":"Budnitz, D. S. et al. US emergency department visits attributed to medication harms, 2017\u20132019. JAMA 326(13), 1299\u20131309 (2021).","journal-title":"JAMA"},{"key":"7712_CR3","first-page":"1","volume":"19","author":"Joint Commission","year":"2018","unstructured":"Joint Commission. National patient safety goal for anticoagulant therapy. R3 Rep. 19, 1\u20134 (2018).","journal-title":"R3 Rep."},{"issue":"2","key":"7712_CR4","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/s40256-021-00502-9","volume":"22","author":"FL Norby","year":"2022","unstructured":"Norby, F. L. et al. Direct oral anticoagulants and warfarin for atrial fibrillation treatment: Rural and urban trends in medicare beneficiaries. Am. J. Cardiovasc. Drugs Drugs, Devices Interv. 22(2), 207\u2013217. https:\/\/doi.org\/10.1007\/s40256-021-00502-9 (2022).","journal-title":"Am. J. Cardiovasc. Drugs Drugs, Devices Interv."},{"issue":"7","key":"7712_CR5","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.21971","volume":"6","author":"CG Derington","year":"2023","unstructured":"Derington, C. G. et al. Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation. JAMA Netw. Open 6(7), e2321971 (2023).","journal-title":"JAMA Netw. Open"},{"issue":"2","key":"7712_CR6","doi-asserted-by":"publisher","first-page":"323","DOI":"10.30574\/wjbphs.2024.17.2.0087","volume":"17","author":"O Babawarun","year":"2024","unstructured":"Babawarun, O., Okolo, C. A., Arowoogun, J. O., Adeniyi, A. O. & Chidi, R. Healthcare managerial challenges in rural and underserved areas: A review. World J. Biol. Pharm. Health Sci. 17(2), 323\u2013330 (2024).","journal-title":"World J. Biol. Pharm. Health Sci."},{"issue":"4","key":"7712_CR7","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1002\/jac5.1936","volume":"7","author":"JE May","year":"2024","unstructured":"May, J. E. et al. Securing administrative leadership commitment for anticoagulation stewardship programs. J. Am. Coll. Clin. Pharm. 7(4), 384\u2013394 (2024).","journal-title":"J. Am. Coll. Clin. Pharm."},{"key":"7712_CR8","unstructured":"Bristol-Myers Squibb Pfizer Inc. Apixaban (Eliquis) Prescribing Information. Published online June 2019. https:\/\/packageinserts.bms.com\/pi\/pi_eliquis.pdf. Accessed 16 Oct 2024."},{"key":"7712_CR9","unstructured":"Boehringer Ingelheim Pharmaceuticals Inc. Dabigatran (Pradaxa) Prescribing Information. Published online March 2018. https:\/\/docs.boehringer-ingelheim.com\/Prescribing%20Information\/PIs\/Pradaxa\/Pradaxa.pdf. Accessed 16 Oct 2024."},{"key":"7712_CR10","unstructured":"Janssen Pharmaceuticals, Inc. Rivaroxaban (Xarelto) Prescribing Information. Published online October 2019. http:\/\/www.janssenlabels.com\/package-insert\/product-monograph\/prescribing-information\/XARELTO-pi.pdf. Accessed 16 Oct 2024."},{"issue":"7","key":"7712_CR11","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1002\/j.1875-9114.2012.01098.x","volume":"32","author":"MA Winter","year":"2012","unstructured":"Winter, M. A., Guhr, K. N. & Berg, G. M. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft\u2013Gault equation. Pharmacother. J. Hum. Pharmacol. Drug Ther. 32(7), 604\u2013612 (2012).","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"7712_CR12","unstructured":"Anticoagulation Forum. DOAC Playbook: A Guide to Practical Management, 2nd edn. Available at: https:\/\/acforum-excellence.org\/Resource-Center\/resource_files\/-2021-04-06-084354.pdf (2021)."},{"key":"7712_CR13","unstructured":"Janssen Pharmaceutical Companies. Aspirin (Asirin) Prescribing Information. Published online January 2013. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2013\/203697Orig1s000lbl.pdf. Accessed 16 Oct 2024."},{"issue":"1","key":"7712_CR14","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","volume":"149","author":"JA Joglar","year":"2024","unstructured":"Joglar, J. A. et al. 2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 149(1), e1\u2013e156. https:\/\/doi.org\/10.1161\/CIR.0000000000001193 (2024).","journal-title":"Circulation"},{"issue":"3","key":"7712_CR15","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12696","volume":"6","author":"KW Sylvester","year":"2022","unstructured":"Sylvester, K. W. et al. Optimization of DOAC management services in a centralized anticoagulation clinic. Res. Pract. Thromb. Haemost. 6(3), e12696 (2022).","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"7712_CR16","doi-asserted-by":"crossref","unstructured":"Allen, A. L., Lucas, J., Parra, D., Spoutz, P., Kibert, J. L., Ragheb, B., Chia, L. & Sipe, A. Shifting the paradigm: A population health approach to the management of direct oral anticoagulants (2021).","DOI":"10.1161\/JAHA.121.022758"},{"issue":"5","key":"7712_CR17","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12757","volume":"6","author":"AE Burnett","year":"2022","unstructured":"Burnett, A. E. & Barnes, G. D. A call to action for anticoagulation stewardship. Res. Pract. Thromb. Haemost. 6(5), e12757 (2022).","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"7712_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12875-021-01590-x","volume":"22","author":"YM Osasu","year":"2021","unstructured":"Osasu, Y. M., Cooper, R. & Mitchell, C. Patients\u2019 and clinicians\u2019 perceptions of oral anticoagulants in atrial fibrillation: A systematic narrative review and meta-analysis. BMC Fam. Pract. 22, 1\u201311 (2021).","journal-title":"BMC Fam. Pract."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-07712-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-07712-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-07712-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T22:59:32Z","timestamp":1751410772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-07712-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,2]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["7712"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-07712-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-6265846\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,2]]},"assertion":[{"value":"20 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was approved by Texas A&M Institutional Review Board (IRB). As this was a retrospective chart review, the requirement for informed consent was waived by Texas A&M IRB. This work was presented as a poster at the Texas Society of Health-System Pharmacists 2024 (TSHP) conference. The authors report no other conflicts of interest in this work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"23064"}}