ผลของระบบสนับสนุนการตัดสินใจทางคลินิกด้วยคอมพิวเตอร์ต่อความเหมาะสม ของการใช้ยาต้านการแข็งตัวของเลือดชนิดกินที่ออกฤทธิ์โดยตรง ในผู้ป่วยภาวะหัวใจห้องบนสั่นพลิ้ว: การใช้ยาต้านการแข็งตัวของเลือดชนิดกินที่ออกฤทธิ์โดยตรง

Porntipha Yoo-um

Authors

Porntipha Yoo-um Department of Pharmacy, Buddhachinaraj Phitsanulok Hospital

Keywords:

computerized clinical decision support system, direct oral anticoagulants, atrial fibrillation

Abstract

Inappropriate prescribing and insufficient follow-up of direct oral anticoagulants (DOACs) among patients with atrial fibrillation (AF) in the Outpatient Department of Buddhachinaraj Phitsanulok Hospital, Thailand, together with reports of serious adverse events, prompted the development of a computerized clinical decision support system (CCDSS) to improve prescribing appropriateness and medication safety. This quasi-experiment study compared the appropriateness and safety of DOAC prescribing before and after CCDSS implementation among AF outpatients. Data were retrospectively collected from October 1, 2024 to April 30, 2025 and patients were followed for three months after implementation from May 1 to July 31, 2025. A total of 202 patients were included; 91 (45.0%) received dabigatran and 111 (55.0%) received apixaban. Guideline-adherent prescribing increased by 7.9%, while the risk of non-adherent prescribing significantly decreased by 48.0% [adjusted risk ratio (aRR) = 0.52, 95% CI: 0.37-0.73, p < 0.001]. Thirty-day hospital readmission showed a downward trend of 2.4% (aRR = 0.48, 95% CI: 0.10-2.18, p = 0.339). Nine drug-drug interaction events were identified; all clinically justified. CCDSS implementation effectively improves appropriate DOAC use, enhance clinical awareness, support systematic medication management, and promote medication safety in patients with AF

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