Risk of Bleeding Associated With Outpatient Use of Rivaroxaban in VTE Management at a National Referral Hospital in Western Kenya.

There is limited data on the bleeding safety profile of direct oral anticoagulants, such as rivaroxaban, in low- and middle-income country settings like Kenya. In this prospective observational study, patients newly started on rivaroxaban or switching to rivaroxaban from warfarin for the management of venous thromboembolism (VTE) within the national referral hospital in western Kenya were assessed to determine the frequency of bleeding during treatment. Bleeding events were assessed at the 1- and 3-month visits, as well as at the end of follow-up. The International Society of Thrombosis and Hemostasis (ISTH) and the Bleeding Academic Research Consortium (BARC) criteria were used to categorize the bleeding events, and descriptive statistics were used to summarize categorical variables. Univariate and multivariate logistic regression model was used to calculate unadjusted and adjusted associations between patient characteristics and bleeding. The frequency of any type of bleeding was 14.4% (95% CI: 9.3%-20.8%) for an incidence rate of 30.9 bleeding events (95% CI: 20.1-45.6) per 100 patient-years of follow-up. The frequency of major bleeding was 1.9% while that of clinically relevant non-major bleeding was 13.8%. In the multivariate logistic regression model, being a beneficiary of the national insurance plan was associated with a lower risk of bleeding, while being unemployed was associated with a higher bleeding risk. The use of rivaroxaban in the management of VTE was associated with a higher frequency of bleeding. These findings warrant confirmation in larger and more targeted investigations in a similar population.

A historical overview of IPPE program administrators' roles and responsibilities at US colleges and schools of pharmacy.

INTRODUCTION: The objective of this research was to determine changes in introductory pharmacy practice experience (IPPE) program administrators' demographics, roles, and responsibilities over time, and reflect on internal and external forces resulting in these shifts. This information provides an opportunity for schools to improve functioning of their IPPE administrative offices. METHODS: A 2020 web-based questionnaire was sent to IPPE program administrators at 141 fully accredited and candidate status colleges and schools of pharmacy (hereafter referred to as schools). The responses were compared to previously published results from similar surveys in 2008 and in 2013. RESULTS: One hundred thirteen IPPE administrators responded to the 2020 questionnaire for an 80% response rate. A comparative analysis of the data from 2008, 2013, and 2020 revealed a decrease in average class size and changes over time in six administrative areas. These areas included IPPE administrator responsibilities, position types, primary administrator's time devoted to IPPE administration, utilization of a programmatic decision-making committee, inclusion on the school's executive committee, and the number of clerical fulltime equivalents utilized in managing IPPE programs. CONCLUSIONS: A comparison of data from three studies revealed significant trends in six areas of IPPE administration over time. The primary drivers of change appear to be workload, fluctuating class sizes, and programmatic costs.