Rates of Potentially Inappropriate Dosing of Direct-Acting Oral Anticoagulants and Associations With Geriatric Conditions Among Older Patients With Atrial Fibrillation: The SAGE-AF Study

Autor: Pia Clive, David D. McManus, Robert J. Goldberg, Molly E. Waring, Robert Hayward, Wenisa Tran, Ziyue Wang, Jane S. Saczynski, Saket Sanghai, Cecillia Wong
Rok vydání: 2020
Předmět:
Male
off‐label dosing
Inappropriate Prescribing
030204 cardiovascular system & hematology
Arrhythmias
0302 clinical medicine
Older patients
Risk Factors
Atrial Fibrillation
Medicine
Drug Dosage Calculations
Drug Interactions
Arrhythmia and Electrophysiology
030212 general & internal medicine
Prospective Studies
Practice Patterns
Physicians'
Original Research
Geriatrics
Aged
80 and over
Quality and Outcomes
Anticoagulant
Age Factors
Atrial fibrillation
Treatment Outcome
Massachusetts
Female
Patient Safety
Cardiology and Cardiovascular Medicine
Direct acting
medicine.medical_specialty
Georgia
medicine.drug_class
Renal function
Hemorrhage
Risk Assessment
Decision Support Techniques
03 medical and health sciences
Internal medicine
Humans
Dosing
Geriatric Assessment
Aged
geriatrics
business.industry
SAGE
anticoagulant
Anticoagulants
medicine.disease
Polypharmacy
Drug Overdose
business
Factor Xa Inhibitors
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background Direct‐acting oral anticoagulant (DOAC) dosing guidelines for atrial fibrillation recommend dose alteration based on age, renal function, body weight, and drug‐drug interactions. There is paucity of data describing the frequency and factors associated with prescription of potentially inappropriate doses. Methods and Results In the ongoing SAGE‐AF (Systematic Assessment of Geriatric Elements in Atrial Fibrillation) study, we performed geriatric assessments (frailty, cognitive impairment, sensory impairments, social isolation, and depression) for participants with atrial fibrillation (age ≥65 years, CHA 2 DS 2 VASc ≥2, no anticoagulant contraindications). We developed an algorithm to analyze DOAC dose appropriateness accounting for drug‐drug interactions, age, renal function, and body weight. We also examined whether geriatric impairments were related to inappropriate dosing. Of 1064 patients prescribed anticoagulants, 460 received a DOAC. Participants were aged 74±7 years, 49% were women, and 82% were white. A quarter (23%; n=105) of participants received inappropriate DOAC dose, of whom 82 (78%) were underdosed and 23 (22%) were overdosed. Among participants receiving an inappropriate dose, 12 (11%) were identified using the drug‐drug interactions criteria and would have otherwise been misclassified. In multivariable regression analyses, older age, higher CHA 2 DS 2 VASc score, and history of renal failure were associated with inappropriate DOAC dosing ( P Conclusions In this cohort, over 20% of older patients with atrial fibrillation treated with DOACs were prescribed an inappropriate dose, with most being underdosed. Drug‐drug interactions were common. Factors that influence prescription of guideline‐nonadherent doses may be perception of higher bleeding risk or presence of renal failure in addition to lack of familiarity with dosing guidelines.
Databáze: OpenAIRE
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