2026 Volume 29 Issue 4 Pages 792-797
Objective: Rapid initiation of andexanet alfa is crucial for patients with major bleeding associated with direct oral anticoagulants. This study aimed to compare decision-to-needle time (DNT) according to pharmacist assignment and to evaluate the potential association of emergency room (ER) pharmacist involvement with DNT.
Methods: We retrospectively analyzed 19 patients who received andexanet alfa at our institution between January 2023 and December 2024. Patients were classified into two groups the ER pharmacist intervention group (Group A, n=12) and the central pharmacy pharmacist group (Group B, n=7). We evaluated changes in DNT before and after the introduction of in-hospital stock and compared DNT between the two groups after stock implementation. DNT was expressed as the median (interquartile range), and group comparisons were performed using the Mann-Whitney U test.
Results: After the introduction of in-hospital stock, the median DNT was significantly shorter in Group A than in Group B (20.0 [17.0-43.0] minutes vs. 87.0 [81.0-167.0] minutes, p=0.008). In both groups, DNT tended to decrease after stock implementation; however, these changes were not statistically significant.
Conclusion: Under the clinical system of our institution, ER pharmacist involvement may be associated with shorter DNT for andexanet alfa administration. However, potential confounding factors, including time of day and treatment location, should be considered when interpreting these findings.
