Table S1.
Adapted medication appropriateness indexa
| Criteria | Category | Instructions |
|---|---|---|
| Indication | A | Valid indication exists |
| B | DOAC used as a last resort or indication does not fit within reimbursement criteria | |
| C | Off-label use | |
| Choice | A | DOAC preferred choice: labile INR with VKA, CI to VKA, patient preference, recurrent stroke/VTE on VKA, resistance to VKA |
| B | No contraindication, not yet tested, no recurrent stroke/VTE on VKA | |
| C | Not preferred choice: severe renal insufficiency, poor compliance, need for drug monitoring, severe hepatic impairment, recurrent VTE/stroke on current DOAC | |
| Dosage | A | Receives daily dose as recommended |
| C | Inappropriate daily dose (too low or too high) | |
| Correct administration | A | Correct modalities of DOAC intake |
| B | Limited clinical relevance for modalities of DOAC intake (rivaroxaban taken in evening, dabigatran taken c/o meals) | |
| C | Inappropriate modalities of DOAC intake (once-daily dabigatran, variable times of intake, rivaroxaban taken without meals) | |
| Practical administration | A | No difficult taking dosage form |
| C | Difficulties taking the drug (dabigatran BID in patients with poor compliance, dabigatran in patients with swallowing difficulties [capsules cannot be opened]) | |
| Drug-drug interactions | A | No DDI |
| B | Potential DDI (caution or warning) without s/sx adverse event | |
| C | DDI contraindication with adverse consequence | |
| Drug-disease interactions | A | No drug-disease interactions |
| B | Potential interaction (caution or warning) without s/sx of worsening disease | |
| C | Contraindicated with disease, presents high risk, or DOAC used with caution and positive s/sx of worsening disease | |
| Therapeutic duplication | A | DOAC is the only antithrombotic |
| B | Concomitant anticoagulant when switching therapy (DOAC to VKA) | |
| C | Duplication of antithrombotic | |
| Duration of therapy | A | Duration in accordance with manufacturer indications |
| C | Duration not appropriate based on recommendations |
Notes: A = appropriate, B = inappropriate with limited clinical importance, C = inappropriate. c/o= without, s/sx = signs and symptoms.
a
Larock AS, Mullier F, Sennesael AL, et al. Ann Pharmacother, 2014;48(10),1258–1268, Copyright ©2014 by SAGE Publications, adapted by permission of SAGE Publications.Inc.1
Abbreviations: BID, twice daily; DDI, drug-drug interaction; INR, international normalization ratio; DOAC, direct oral anticoagulant; VKA, vitamin K antagonist; VTE, venous thromboembolism.