Direct Oral Anticoagulants in the Real World: Insights into Canadian Health Care Providers’ Understanding of Medication Dosing and Use

Background: Direct-acting oral anticoagulant (DOAC) use is increasing in Canada. This study evaluated nurse, staff physician, and resident physician understanding of DOAC dosing and administration. Methods: An electronic survey was distributed to health care providers (HCPs) at a hospital in Ontario, Canada. The questions discussed oral anticoagulant indications, dose adjustments, storage and administration, and counselling. Results: A total of 52 responses were received: 3 from nurses, 1 from a nurse practitioner, 21 from staff physicians (Hematology, Thrombosis Medicine, General Internal Medicine, Neurology), 25 from resident physicians, and 2 unspecified respondents. Twenty-four respondents (46%) felt comfortable or very comfortable prescribing DOACs. Only 15 (29%) knew that dabigatran should not be exposed to moisture and 13 (25%) knew that higher doses of rivaroxaban should be taken with food. Conclusion: HCP understanding of DOACs is variable. Though they express comfort with DOACs, their self-reported knowledge of dosing, administration, and patient counselling is incomplete.