| アブストラクト | INTRODUCTION: Per-label dosing of direct oral anticoagulants (DOACs) is important for the prevention of stroke and systemic embolism among patients with non-valvular atrial fibrillation (NVAF), especially those with poor renal function, advanced age, low body weight or concomitant P-glycoprotein inhibitors. The study described DOAC use and dosing patterns in patients with NVAF in the UK. METHODS: Using Clinical Practice Research Datalink (CPRD Gold), patients' profiles were described at DOAC initiation (1 January 2016-31 March 2021) and followed for a mean [standard deviation (SD)] 2 (1) years. Patients were categorised as under-dosing: received a lower dose with no indication for a reduced dose; over-dosing: received a standard dose with an indication for a reduced dose; per-label dosing, according to Summary Product Characteristics (SmPC). RESULTS: Forty thousand seven hundred forty-four adult patients with NVAF were identified (mean age: 75.3 (11.2) years; males: 55.4%); 22,827 (56.0%) initiated treatment with apixaban, 930 (2.3%) dabigatran, 5633 (13.8%) edoxaban and 11,354 (27.9%) rivaroxaban. Baseline Charlson comorbidity index >/= 4 was 65.1%; CHA(2)DS(2)-VASc score >/= 4 was 22.5%; HAS-BLED score >/= 3 was 18.3%; ~ 2% had prior major bleed and 4.4% a stroke </= 2 years before DOAC initiation. Overall, 18.0% of patients received incorrect dosing (~ one in five). Under-dosing was highest for dabigatran (156, 16.8%) and over-dosing was highest for rivaroxaban (1084, 9.6%). Per-label dosing was highest for edoxaban (4773, 84.7%), followed by apixaban (18,756, 82.2%), rivaroxaban (9161, 80.7%) and dabigatran (732, 78.7%). Treatment persistence (no switching or discontinuation) was 79% among edoxaban users, followed by 75% for apixaban, 69% for rivaroxaban and 62% for dabigatran. About 15% of dabigatran users, 10% of rivaroxaban users, 5% of apixaban users and 4% of edoxaban users switched treatment to another DOAC during follow-up. CONCLUSION: Although most patients received per-label dosing, ~ one in five patients was incorrectly dosed with DOAC, which may lead to serious clinical consequences and increased healthcare burden. |
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| ジャーナル名 | Advances in therapy |
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| Pubmed追加日 | 2022/11/19 |
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| 投稿者 | Khachatryan, Artak; Doobaree, Indraraj Umesh; Spentzouris, George; Gusto, Gaelle; Zawaneh, Yousef; Mughal, Farhan; Anastassopoulou, Anastassia; Manu, Marius; Fay, Matthew |
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| 組織名 | Evidence and Access, Certara, London, UK.;Daiichi Sankyo Europe, Munich, Germany.;Evidence and Access, Certara, Paris, France.;Daiichi Sankyo UK, Uxbridge, UK.;Anastassia.Anastassopoulou@daiichi-sankyo.eu.;Warwick Medical School, Warwick University, Warwick, UK.;The Willows Medical Practice, Bradford, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/36399317/ |
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