Medication Errors associated with Direct Oral Anticoagulants: A Systematic Review


  • Laila Alharbi College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  • Metab Saleh Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia


Medication error, Preventable adverse drug event, Medication-related harm, Inappropriate prescribing, Anticoagulants


Background: Direct oral anticoagulants (DOACs) have favorable safety and efficacy outcomes in treating and preventing different thrombotic events compared to warfarin.  DOACs are mainly eliminated through the kidney; therefore, poor renal function is one of the important patient-related factors related to DOACs prescription errors.  Our objective was to systematically review evidence related to the prevalence, risk factors, and characteristics of inappropriate DOACs prescription practices. 

Methods: The search was conducted in PubMed and Scopus databases from 2011to 2021.  We included any study that involved DOACs use among adults >18.  Modified Newcastle-Ottawa Scale was used to assess the quality of selected articles.

Results: As a result of our search strategy, we found 19 articles that met the inclusion criteria.  The prevalence of DOACs inappropriate prescription ranged from 6% to 60%.  The most commonly reported inappropriate prescription was underdosing.  Renal impairment was an important factor related to inappropriate DOACs prescriptions.

Conclusion: Appropriateness of the DOACs prescription practice remains a concern, with underdosing as the most reported dosing-related problem.  Renal impairment among the patients-related factors increases the risk of inappropriate dosing.



How to Cite

Alharbi, L., & Saleh, M. . (2022). Medication Errors associated with Direct Oral Anticoagulants: A Systematic Review . Journal of Health Informatics in Developing Countries, 16(1). Retrieved from



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