Characteristics of patients with atrial fibrillation treated with direct oral anticoagulants and new insights into inappropriate dosing: results from the French National Prospective Registry: PAFF.
Atrial fibrillation
Direct oral anticoagulant
Inappropriate dosing
Journal
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092
Titre abrégé: Europace
Pays: England
ID NLM: 100883649
Informations de publication
Date de publication:
05 Oct 2023
05 Oct 2023
Historique:
received:
26
07
2023
accepted:
14
09
2023
medline:
1
11
2023
pubmed:
6
10
2023
entrez:
6
10
2023
Statut:
ppublish
Résumé
Since the introduction of direct oral anticoagulant (DOAC) for atrial fibrillation (AF) therapy, inappropriate and/or underdosing of these drugs has been a major clinical challenge. We evaluated the characteristics of patients with AF treated with inappropriate and low-dose DOACs. Patients with AF treated with inappropriate and low-dose DOACs from October 2021 to December 2021 were evaluated from the French National Prospective Registry (PAFF). We evaluated 1890 patients with AF receiving DOACs (apixaban 55%, dabigatran 7%, and rivaroxaban 38%). Inappropriate dosing was noted in 18% of the population. Patients with appropriate dosing had less comorbidities: younger age (75 ± 10 vs. 82 ± 8 years old, P < 0.0001), reduced chronic renal failure (26 vs. 61%, P < 0.0001), and lower CHA2DS2VASc and HASBLED scores (3 ± 2 vs. 4 ± 3, P < 0.0001; 2 ±1 vs. 2 ± 2, P < 0.0001), respectively. In multivariate analysis, older age (P < 0.0001) and a higher CHA2DS2VASc score (P = 0.0056) were independently associated with inappropriate DOAC dosing. Among 472 patients (27%) treated with low-dose rivaroxaban or apixaban, 46% were inappropriately underdosed. Patients inappropriately underdosed were younger (82.3 ± 8.4 vs. 85.9 ± 5.9 years, P < 0.0001) with less chronic renal disease (47 vs. 98%, P < 0.0001). However, these patients had higher rates of prior haemorrhagic events (18 vs. 10%, P = 0.01), clopidogrel use (11 vs. 3%, P = 0.0002), and apixaban prescription (74 vs. 50%, P < 0.0001). Within this large registry, DOACs were associated with inappropriate dosing in 18% of cases. Independent predictors of inappropriate dosing were high CHA2DS2VASc scores and older age. Moreover, 46% of patients treated with low-dose DOACs were inappropriately underdosed and more frequently in patients treated with apixaban.
Identifiants
pubmed: 37801642
pii: 7293715
doi: 10.1093/europace/euad302
pmc: PMC10590101
pii:
doi:
Substances chimiques
Rivaroxaban
9NDF7JZ4M3
Anticoagulants
0
Dabigatran
I0VM4M70GC
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Bayer
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Déclaration de conflit d'intérêts
Conflict of interest: N.L. received consulting fees from Bayer and BMS-Pfizer.
Références
Br J Gen Pract. 2021 Jan 28;71(703):e134-e139
pubmed: 33495204
Europace. 2018 Oct 1;20(10):1577-1583
pubmed: 29186393
Europace. 2022 Oct 13;24(9):1404-1411
pubmed: 35512229
Eur J Clin Pharmacol. 2022 May;78(5):879-886
pubmed: 35138442
J Stroke Cerebrovasc Dis. 2018 Nov;27(11):3280-3288
pubmed: 30121155
Eur Heart J. 2020 Jan 14;41(3):407-477
pubmed: 31504439
J Intern Med. 2018 Jan;283(1):45-55
pubmed: 28861925
Eur Heart J. 2016 Apr 7;37(14):1145-53
pubmed: 26330425
Kidney Int. 2005 Jun;67(6):2089-100
pubmed: 15882252
Eur Heart J. 2020 Jan 7;41(2):255-323
pubmed: 31497854
Am J Cardiol. 2021 Apr 1;144:52-59
pubmed: 33385355
J Thromb Thrombolysis. 2017 Feb;43(2):149-156
pubmed: 27757787
N Engl J Med. 2016 Dec 22;375(25):2423-2434
pubmed: 27959713
J Patient Saf. 2022 Jun 1;18(4):337-341
pubmed: 35617592
Eur Heart J. 2013 Sep;34(35):2746-51
pubmed: 23900699
PEC Innov. 2022 Jun 30;1:100062
pubmed: 37213758
N Engl J Med. 2011 Sep 15;365(11):981-92
pubmed: 21870978
Europace. 2019 Mar 1;21(3):421-427
pubmed: 30052894
N Engl J Med. 2011 May 12;364(19):1788-90
pubmed: 21488759
Br J Clin Pharmacol. 2020 Aug;86(8):1567-1574
pubmed: 32090369
J Am Coll Cardiol. 2020 Sep 22;76(12):1425-1436
pubmed: 32943160
Eur Heart J. 2021 Feb 1;42(5):373-498
pubmed: 32860505
J Am Coll Cardiol. 2017 Jun 13;69(23):2779-2790
pubmed: 28595692
J Cardiovasc Med (Hagerstown). 2020 Oct;21(10):751-758
pubmed: 32740435
J Am Coll Cardiol. 2016 Dec 20;68(24):2597-2604
pubmed: 27978942
Europace. 2020 Mar 1;22(3):361-367
pubmed: 31985781
Eur Heart J. 2018 Sep 1;39(33):3021-3104
pubmed: 30165516
N Engl J Med. 2011 Sep 8;365(10):883-91
pubmed: 21830957
Ther Adv Drug Saf. 2018 May 17;9(8):405-414
pubmed: 30364869
J Thromb Thrombolysis. 2019 May;47(4):550-557
pubmed: 30689152
Thromb J. 2019 Apr 25;17:7
pubmed: 31169831
N Engl J Med. 2009 Sep 17;361(12):1139-51
pubmed: 19717844
Eur Heart J. 2018 Apr 21;39(16):1330-1393
pubmed: 29562325