{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T19:42:04Z","timestamp":1771357324743,"version":"3.50.1"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100007197","name":"U.S. Public Health Service","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007197","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"crossref","award":["R18HS026874"],"award-info":[{"award-number":["R18HS026874"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100001502","name":"Blue Cross Blue Shield of Michigan Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001502","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>\n            Background\u2003While direct oral anticoagulants (DOACs) may be viewed as simpler to manage then warfarin, they present their own unique management challenges resulting in frequent off-label dosing. It is unknown to what extent off-label dosing occurs when a patient is started on a DOAC versus later in their treatment.<\/jats:p><jats:p>\n            Objectives\u2003We aimed to better characterize when off-label DOAC dosing is occurring and to evaluate the effectiveness of prescribing oversight using a registry-based intervention.<\/jats:p><jats:p>\n            Methods\u2003We evaluated data from the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry, a retrospective quality-improvement process using data abstractors, from 2018 to 2022 on the number of \u201calerts\u201d that are generated in response to dosing deviating from the U.S. Food and Drug Administration instructions for atrial fibrillation (AF) and venous thromboembolism (VTE).<\/jats:p><jats:p>\n            Results\u2003Among a sample of 789 to 1,022 annual AF patients and 381 to 484 annual VTE patients prescribed a DOAC in the MAQI2 registry, off-label dosing was relatively common. Over the 5-year period (2018\u20132022), there were 569 alerts for AF patients and 162 alerts for VTE patients. Alerts occurred more frequently during follow-up than at the time of initial prescribing in AF patients (78.2 vs. 21.8%), but more commonly at initial prescribing in VTE patients (59.9 vs. 40.1%). After initial review by quality-improvement abstractors, 19.3% of AF alerts and 14.8% of VTE alerts resulted in contact to the prescriber. When the prescriber was contacted, it led to an intervention about 75% of the time for both populations. The most common intervention was a change in DOAC dosing.<\/jats:p><jats:p>\n            Conclusion\u2003This study demonstrates the benefit of DOAC prescribing oversight using a registry-based intervention to monitor for off-label dosing for the entirety of the time period a patient is prescribed DOAC, particularly for patients with AF, as off-label prescribing occurs frequently during the follow-up period.<\/jats:p>","DOI":"10.1055\/a-2365-8681","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T22:59:56Z","timestamp":1721084396000},"page":"278-285","source":"Crossref","is-referenced-by-count":3,"title":["Timing of Off-Label Dosing of Direct Oral Anticoagulants in Three Large Health Systems"],"prefix":"10.1055","volume":"125","author":[{"given":"Grace C.","family":"Herron","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"DeCamillo","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowen","family":"Kong","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Haymart","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Kaatz","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Medicine, Henry Ford Health, Detroit, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacy","family":"Ellsworth","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Henry Ford Health, Detroit, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona A.","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Heart and Vascular Services, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Giuliano","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, United States"},{"name":"Ascension St. John Hospital, Detroit, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James B.","family":"Froehlich","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6532-8440","authenticated-orcid":false,"given":"Geoffrey D.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jacc.2019.01.011","article-title":"2019 AHA\/ACC\/HRS focused update of the 2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"74","author":"C T January","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1016\/j.chest.2021.07.056","article-title":"Executive summary","volume":"160","author":"S M Stevens","year":"2021","journal-title":"Chest"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s13012-020-01044-5","article-title":"Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol","volume":"15","author":"G D Barnes","year":"2020","journal-title":"Implement Sci"},{"issue":"11","key":"ref4","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/j.amjmed.2016.05.041","article-title":"Evaluation of dose-reduced direct oral anticoagulant therapy","volume":"129","author":"M E Barra","year":"2016","journal-title":"Am J Med"},{"issue":"24","key":"ref5","doi-asserted-by":"crossref","first-page":"2597","DOI":"10.1016\/j.jacc.2016.09.966","article-title":"Off-label dosing of non-vitamin K antagonist oral anticoagulants and adverse outcomes: the ORBIT-AF II registry","volume":"68","author":"B A Steinberg","year":"2016","journal-title":"J Am Coll Cardiol"},{"issue":"22","key":"ref6","doi-asserted-by":"crossref","first-page":"e016949","DOI":"10.1161\/JAHA.120.016949","article-title":"Correcting inappropriate prescribing of direct oral anticoagulants: a population health approach","volume":"9","author":"T Dawson","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1177\/1076029615614395","article-title":"PRescriptiOn PattERns of oral anticoagulants in nonvalvular atrial fibrillation (PROPER study)","volume":"23","author":"O Basaran","year":"2017","journal-title":"Clin Appl Thromb Hemost"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1160\/TH16-07-0494","article-title":"Real-life treatment of venous thromboembolism with direct oral anticoagulants: the influence of recommended dosing and regimens","volume":"117","author":"J Trujillo-Santos","year":"2017","journal-title":"Thromb Haemost"},{"issue":"02","key":"ref9","first-page":"134","article-title":"Impact of variations in kidney function on nonvitamin K oral anticoagulant dosing in patients with atrial fibrillation and recent acute heart failure","volume":"69","author":"J M Andreu-Cayuelas","year":"2016","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1111\/jth.13985","article-title":"Variation of renal function over time is associated with major bleeding in patients treated with direct oral anticoagulants for atrial fibrillation","volume":"16","author":"C Becattini","year":"2018","journal-title":"J Thromb Haemost"},{"issue":"24","key":"ref11","doi-asserted-by":"crossref","first-page":"e022758","DOI":"10.1161\/JAHA.121.022758","article-title":"Shifting the paradigm: a population health approach to the management of direct oral anticoagulants","volume":"10","author":"A L Allen","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"e009256","DOI":"10.1161\/CIRCOUTCOMES.122.009256","article-title":"Nationwide implementation of a population management dashboard for monitoring direct oral anticoagulants: insights from the veterans affairs health system","volume":"16","author":"M P Dorsch","year":"2023","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"e12757","DOI":"10.1002\/rth2.12757","article-title":"A call to action for anticoagulation stewardship","volume":"6","author":"A E Burnett","year":"2022","journal-title":"Res Pract Thromb Haemost"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"e12758","DOI":"10.1002\/rth2.12758","article-title":"Anticoagulation stewardship: descriptive analysis of a novel approach to appropriate anticoagulant prescription","volume":"6","author":"M Koolian","year":"2022","journal-title":"Res Pract Thromb Haemost"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1310\/hpj5203-207","article-title":"Assessment of direct oral anticoagulant prescribing and monitoring pre- and post-implementation of a pharmacy protocol at a community teaching hospital","volume":"52","author":"C Miele","year":"2017","journal-title":"Hosp Pharm"},{"issue":"11","key":"ref16","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1002\/jac5.1503","article-title":"Impact of a pharmacist-to-dose direct oral anticoagulant protocol on medication errors at an academic medical center","volume":"4","author":"A Willeford","year":"2021","journal-title":"JACCP J Am Coll Clin Pharm"},{"issue":"16","key":"ref17","doi-asserted-by":"crossref","first-page":"3526","DOI":"10.1007\/s11606-023-08315-z","article-title":"Multicomponent pharmacist intervention did not reduce clinically important medication errors for ambulatory patients initiating direct oral anticoagulants","volume":"38","author":"A Kapoor","year":"2023","journal-title":"J Gen Intern Med"},{"issue":"07","key":"ref18","doi-asserted-by":"crossref","first-page":"e2321971","DOI":"10.1001\/jamanetworkopen.2023.21971","article-title":"Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation","volume":"6","author":"C G Derington","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"09","key":"ref19","doi-asserted-by":"crossref","first-page":"e2231973","DOI":"10.1001\/jamanetworkopen.2022.31973","article-title":"Assessment of an intervention to reduce aspirin prescribing for patients receiving warfarin for anticoagulation","volume":"5","author":"J K Schaefer","year":"2022","journal-title":"JAMA Netw Open"}],"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2365-8681.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:16:09Z","timestamp":1740528969000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2365-8681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,15]]},"references-count":19,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2025,2,25]]},"published-print":{"date-parts":[[2025,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2365-8681","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,7,15]]},"published":{"date-parts":[[2024,7,15]]}}}