Prevalence and risk of inappropriate dosing of direct oral anticoagulants in two Swiss atrial fibrillation registries
| Autor: | Giulia Montrasio, Martin F. Reiner, Andrea Wiencierz, Stefanie Aeschbacher, Christine Baumgartner, Nicolas Rodondi, Michael Kühne, Giorgio Moschovitis, Helga Preiss, Michael Coslovsky, Maria L. De Perna, Leo H. Bonati, David Conen, Stefan Osswald, Juerg H. Beer, Pascal Koepfli |
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| Přispěvatelé: | University of Zurich, Montrasio, Giulia |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Pharmacology
Physiology Administration Oral Anticoagulants Hemorrhage 610 Medicine & health 1314 Physiology Brain Ischemia Stroke 3004 Pharmacology Fibrinolytic Agents 1313 Molecular Medicine Atrial Fibrillation Prevalence 10209 Clinic for Cardiology Molecular Medicine Humans Female Prospective Studies Registries 360 Social problems & social services Switzerland |
| Popis: | BACKGROUND Direct oral anticoagulants (DOACs) have a favourable risk-benefit profile compared to vitamin K-antagonists (VKAs) in atrial fibrillation (AF). Dosing is based on age, weight and renal function, without need of routine monitoring. METHODS AND RESULTS In two prospective, multicentre AF cohorts (Swiss-AF, BEAT-AF) patients were stratified as receiving VKAs or adequately-, under- or overdosed DOACs, according to label. Primary outcome was a composite of major adverse clinical events (MACE), defined as cardiovascular death, myocardial infarction (MI), ischaemic stroke and systemic embolism. Secondary outcomes included major bleeding. Adjustment for confounding was performed. Median follow-up was 4 years. Of 3236 patients, 1875 (58%) were on VKAs and 1361 (42%) were on DOACs, of which 1137 (83%) were adequately-, 134 (10%) over- and 90 (7%) under-dosed. Compared to adequately dosed individuals, overdosed patients were more likely to be older and female. Underdosing correlated with concomitant aspirin therapy and coronary artery disease. Both groups had higher CHA2DS2-VASc scores. Patients on overdosed DOACs had higher incidence of MACE (HR 1.75; CI 1.10-2.79; adjusted-HR: 1.22) and major bleeding (HR 1.99; CI 1.14-3.48; adjusted-HR: 1.51). Underdosing was not associated with a higher incidence of MACE (HR 0.94; CI 0.46-1.92; adjusted-HR 0.61) or major bleeding (HR 1.07; CI 0.46-2.46; adjusted-HR 0.82). After adjustment, all CIs crossed 1.0. CONCLUSION Inappropriate DOAC-dosing was more prevalent in multimorbid patients, but did not correlate with higher risks of adverse events after adjusting for confounders. DOAC prescription should follow label. |
| Databáze: | OpenAIRE |
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