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Europace. 2018 Oct 1;20(10):1577-1583. doi: 10.1093/europace/eux316.

Inappropriate doses of direct oral anticoagulants in real-world clinical practice: prevalence and associated factors. A subanalysis of the FANTASIIA Registry.

Author information

1
Department of Cardiology, University Hospital Reina Sofia, Avenida Menéndez Pidal s/n, 14004 Córdoba, Spain.
2
Universidade da Coruña, Instituto Universitario de Ciencias de la Salud e INIBIC, Hospital Marítimo de Oza, Edificio "O Fortín", As Xubias s/n, 15006 A Coruña, Spain.
3
Odds SL., C/ Wenceslado Fernández Flórez, n°1 - n°2, 15005 A Coruña, Spain.
4
Department of Cardiology, University Hospital La Paz, IDIPAZ, CIBER-CV, Paseo de la Castellana, 261, 28046 Madrid, Spain.
5
Department of Cardiology, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, CIBER-CV, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain.
6
Department of Cardiology, University Hospital of Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
7
Department of Cardiology, University Hospital Gregorio Marañón, CIBER-CV, Complutense University and European University, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain.
8
Department of Cardiology, University Hospital San Juan, Carretera Nacional 332, s/n, 03550 Alicante, Spain.

Abstract

Aims:

To describe the prevalence and associated factors of inappropriate doses of direct oral anticoagulants (DOAC) in a national registry of patients of real clinical practice.

Methods and results:

Five hundred and thirty outpatients with atrial fibrillation treated with DOAC were included in a prospective, national, multicentre study. The appropriateness of the doses of DOAC was defined according to the recommendations of the European Heart Rhythm Association. Mean age was 73 ± 9 years, with a 46% of women. Two hundred and sixty-seven patients were prescribed dabigatran, 190 rivaroxaban, and 73 apixaban. A total of 172 patients (32%) did not receive the appropriate dose: 93 patients received a lower dose (18%) and 79 patients a higher dose (15%). In the comparisons among the subgroups of inappropriately low, appropriate, and inappropriately high dose, we observed significant trends to older age (69 ± 8 years vs. 73 ± 10 years vs. 77 ± 6 years), more frequent female sex (37% vs. 46% vs. 59%), antiplatelet drugs (5% vs. 8% vs. 25%), rivaroxaban (14% vs. 38% vs. 53%), and apixaban use (5% vs. 15% vs. 19%), higher CHAD2DS2-VASc (3.00 ± 1.38 vs. 3.58 ± 1.67 vs. 4.59 ± 1.44) and HAS-BLED scores (1.83 ± 0.87 vs. 1.92 ± 1.07 vs. 2.47 ± 1.13), lower body mass index (30 ± 6 kg/m2 vs. 29 ± 4 kg/m2 vs. 28 ± 4 kg/m2) and glomerular filtration rate (74 ± 27 mL/min vs. 70 ± 22 mL/min vs. 63 ± 16 mL/min), and lower frequency of dabigatran use (81% vs. 47% vs. 28%) (all comparisons P ≤ 0.01).

Conclusion:

In this real-life study, 32% of patients received an inappropriate dose of DOAC. Several clinical factors can identify patients at risk of this situation.

PMID:
29186393
DOI:
10.1093/europace/eux316
[Indexed for MEDLINE]

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