Skip to main content

Table 5 Advices given by the pharmacist

From: Evaluation and validation of a clinical decision support system for dose optimisation in hospitalized patients with (morbid) obesity – a retrospective, observational study

 

No action

Drug switch

Dosage increase

Dosage decrease

Continuous administration

TDM

Laboratorial measurement

Dabigatran

1

6

N/A

N/A

N/A

N/A

N/A

Edoxaban

N/A

1

N/A

N/A

N/A

N/A

N/A

Ciprofloxacin

11

N/A

31

N/A

N/A

N/A

1

Vancomycin

9

N/A

2

N/A

1

9

N/A

Dalteparin - collectively

74

N/A

390

3

N/A

43

1

Dalteparin - anti-Xa level

16

N/A

N/A

1

N/A

33

1

Dalteparin - therapeutic

22

N/A

32

1

N/A

9

N/A

Dalteparin - prophylactic

36

N/A

358

1

N/A

1

N/A

  1. Abbreviation: TDM, therapeutic drug monitoring; N/A, not applicable