TRC Conversation: Preventing Stroke in Atrial Fibrillation

Sep 30, 2014
A strong roster of pharmacists specializing in patients with needs in a specific area, like our Cardiovascular TRC, is one of the unique ways Express Scripts helps patients stay on the right treatment and avoid unnecessary, harmful adverse events.
Tags
  • High Blood Pressure/Heart Disease

What Happened?

A 62-year-old man is prescribed a 90-day supply of Xarelto® (rivaroxaban) at 10mg daily for stoke prevention.

Clinical Gap in Care

Xarelto is an oral anticoagulant used to prevent stroke in atrial fibrilation.

A 10mg dose of this drug is typically only prescribed for a short duration of therapy such as post-hip or knee replacement.

Long-term therapy for the prevention of stroke in nonvalvular atrial fibrillation normally requires a 15mg or 20mg daily dose.

Incorrect dosing may expose a patient to a risk of stroke or major bleed.

Case Study Stroke Prevention

This is a clip of an actual call from Express Scripts specialist pharmacist explaining the dosage risk to the prescribing physician.

Specialist Pharmacist Intervention

Specialist pharmacists perform concurrent drug utilization review (CDUR) on specific inbound prescriptions to ensure safe and appropriate use of medications for chronic and complex conditions.  When clinically necessary, specialist pharmacists contact prescribers to clarify or correct prescriptions due to safety concerns raised during the CDUR process. For members who register on Express-Scripts.com, specialist pharmacists develop drug-therapy-specific adherence, omission and safety alerts, as well as recommending drug-therapy education materials. Members with mobile app access also receive clinical alerts.

The Express Scripts Cardiovascular Therapeutic Resource Center® created a unique alert that allows pharmacists the opportunity to evaluate prescriptions for Xarelto 10mg that may be dosed either too long following a knee or hip replacement or at a daily dose too low for the prevention of stroke in atrial fibrillation.

A cardiovascular specialist pharmacist contacted the prescriber’s office to address the different strengths and duration of Xarelto therapy.

Why It Matters

After a discussion with our specialist pharmacist, the physician changed the prescription to Xarelto 20mg daily, in line with long-term therapy.

A strong roster of pharmacists specializing in patients with needs in a specific area, like our Cardiovascular TRC, is one of the unique ways Express Scripts helps patients stay on the right treatment and avoid unnecessary, harmful adverse events. We call it Health Decision Science: the application of clinical specialization and behavioral sciences combined with actionable data to enable better decisions and healthier outcomes.

Click to view an overview of this conversation.

Author Bio

Lab Staff
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