# Exploring the knowledge level and practices of hospital pharmacists in management of oral anticoagulants in Gulf Cooperation Council countries: a scoping review of literature

## TL;DR

This review finds that hospital pharmacists in GCC countries have gaps in knowledge and practices related to managing oral anticoagulants, which could impact patient safety.

## Contribution

The study provides a scoping review of hospital pharmacists' knowledge and practices on OACs in GCC countries, highlighting regional gaps.

## Key findings

- Hospital pharmacists in GCC countries show inadequate knowledge and suboptimal practices in managing OACs, particularly warfarin and DOACs.
- Studies revealed insufficient knowledge of drug interactions and lower confidence in counselling on DOACs compared to vitamin K antagonists.
- All studies used self-reported data and focused on community pharmacists, not exclusively hospital pharmacists, limiting generalizability.

## Abstract

Oral anticoagulants (OACs) are essential for managing thromboembolic events and cardiovascular conditions. However, they carry a significant bleeding risk. Pharmacists play a critical role in ensuring the safe and effective use of these medications. Within Gulf Cooperation Council (GCC) countries, hospital pharmacists are involved in managing OACs. However, region specific data on their knowledge and practices remain limited.

This review analysed existing literature regarding hospital pharmacists’ knowledge and practices in OACs dispensing and counselling within the GCC countries.

A literature search was conducted in Scopus, Web of Science, PubMed and PsycINFO. Articles that explored the hospital pharmacist’s knowledge and practices regarding OACs were included. There were no restrictions on study design, publication date, or language. Searches were undertaken on February 1, 2025 then re-run on October 28, 2025, following PRISMA-ScR and JBI guidelines.

Findings revealed gaps in pharmacists’ knowledge and practices regarding OACs management. Out of 75 articles identified, seven met inclusion criteria, representing studies from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). All were cross-sectional and utilized validated questionnaires. A study from Saudi Arabia and another from the UAE reported gaps in warfarin knowledge. Counselling practices were suboptimal in both studies. One study further identified insufficient knowledge of warfarin interactions. Beyond warfarin, one study reported deficiencies in rivaroxaban knowledge and counselling, while another found moderate awareness of direct oral anticoagulants (DOACs) (mean score 41.6% ± 26%). Another study reported inadequate practice in OACs dispensing and monitoring, and another study found greater pharmacists’ confidence in counselling on vitamin K antagonists (VKAs) (67%) than on DOACs (49%).

Findings highlight inadequate knowledge and practice among pharmacists regarding OACs. Although all studies included community pharmacists and other healthcare providers, none focused exclusively on hospital pharmacists, who are more directly involved in OAC management in the GCC. All studies relied solely on self-reported data, increasing bias. Most studies originated from Qatar, Saudi Arabia, and the UAE, reducing generalizability. Nevertheless, addressing knowledge gaps could improve hospital pharmacists’ practice on OACs management, improving patient safety, and optimising therapeutic outcomes.