P59 An audit reviewing compliance to venous thrombosis (VT) rivaroxaban guideline

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Introduction Rivaroxaban is an oral anticoagulant and selective direct inhibitor of factor anti Xa. It is licensed for use in term neonates and children up to 18 years old for VT. 1 Prior to the use of rivaroxaban, standard treatment was with subcutaneous therapeutic enoxaparin, which required training, monitoring and often was not well tolerated by patients. Rivaroxaban has the benefit of not requiring regular monitoring.After rivaroxaban licensing, a guideline was developed by a multidisciplinary team, using evidence from the EINSTEIN-Jr trial, to guide the prescribing and administration, within the trust and the surrounding region.2 Anticoagulants have been highlighted as a major cause of adverse events and hospital admissions, so their safe prescribing and administration are critical.3 This audit will review the use of rivaroxaban within the hospital, to ensure that it complies with the guideline.4 Method Patients, who had rivaroxaban dispensed between the 1st April 2023 and the 31st March 2024, were identified using the Pharmacy dispensing system. The electronic medical records were then reviewed, to identify the indication for rivaroxaban.Patients’ exclusions were those having rivaroxaban for primary thromboprophylaxis for a Fontan circulation and those patients who did not have a full scanned set of medical notes.The audit standards included 100% of patients should have a haematology review documented in the medical notes, 100% of patients were prescribed the correct dose as per guideline, 100% of patients had the correct baseline blood tests, including full blood count, clotting factors, electrolytes and creatinine within 5 days of rivaroxaban being initiated.In addition, a review of the rivaroxaban formulation supplied to each patient; granules or tablets was documented.Results A total of 28 patients were identified for this audit between the 1st April 2023 and the 31st March 2024; 2 patients were excluded as they did not have full scanned medical notes and 5 patients had Fontan circulation. A total number of 21 patients were included in the audit.95% had a haematology review documented in the medical notes, 100% of the patients received the correct dose as per the guideline. 78% had all the correct baseline monitoring conducted. Of the 22% of patients that did not have the correct baseline monitoring within 5 days of initiating rivaroxaban, all of these received this monitoring within 7 days of initiating rivaroxaban.62% of the patients were supplied Rivaroxaban granules for oral suspension, 38% were supplied tablets as either 5 mg, 15 mg or 20 mg tablets.Conclusion The audit showed that largely patients’ VT treatment with rivaroxaban, complied with the guideline, giving assurance that medical teams are referring appropriately and requesting the correct monitoring for a drug that is deemed high risk. These findings will be presented to the haematology team with recommendations for improvements in baseline monitoring and appropriate timeframes. Further work identified will be assessing the different medical teams using rivaroxaban and the counselling provided on discharge.References Bayer PLC. Xarelto (Rivaroxaban) 20mg film-coated tablets summary of product characteristics. Electronic Medicines Compendium [Internet]. 2023 Available from: https://www.medicines.org.uk/emc/product/2793/smpc (Accessed 17 July 2024)Male C, Lensing A, Palumbo J, et al. Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial. The Lancet Haematology 2020;7:e18–e27NHS National Patient Safety Agency. Actions that can make anticoagulation safer [Internet]. 2007. Available from: www.npsa.nhs.uk/health/alerts/formats?contentId=3092 (Accessed 15 July 2024)Moppett J, Knott A, Gage S. Use of rivaroxaban in neonates and children following venous thrombosis. University Hospitals Bristol and Weston NHS Foundation Trust. 2022.

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