P1898Prevalence and risk of DOACs inappropriate dosing in atrial fibrillation. An analysis of the Swiss-AF and BEAT-AF registries
| العنوان: | P1898Prevalence and risk of DOACs inappropriate dosing in atrial fibrillation. An analysis of the Swiss-AF and BEAT-AF registries |
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| المؤلفون: | J H Beer, M S Kuehne, G Montrasio, Andrea Wiencierz, Nicolas Rodondi, D. Conen, Giorgio Moschovitis, M L De Perna, Stefan Osswald, Michael Coslovsky, C Baumgartner, Martin F Reiner, H Preiss, P Koepfli |
| المصدر: | European Heart Journal. 40 |
| بيانات النشر: | Oxford University Press (OUP), 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | medicine.medical_specialty, business.industry, Internal medicine, medicine, Cardiology, Atrial fibrillation, Dosing, Cardiology and Cardiovascular Medicine, medicine.disease, business, Beat (music) |
| الوصف: | Background Direct oral anticoagulants (DOACs) have a similar efficacy in terms of stroke and mortality reduction as compared to Vitamin K-Antagonists (VKAs) and improved safety with regards to intracranial haemorrhage in patients with non-valvular atrial fibrillation (AF). Dose of DOACs needs to be adjusted according to age, weight, renal function and concomitant medication. Yet, off-label dosages have been reported in 11 - 45% of patients (on average 20%). Purpose To assess the prevalence of inappropriate DOAC-dosing according to the official prescribing information in two large prospective Swiss AF cohorts (Swiss-AF and BEAT-AF) and to evaluate its correlation with adverse clinical outcomes. Methods All 3267 patients taking oral anticoagulants were stratified at baseline as receiving DOACs (adequately dosed, under- or overdosed) or VKAs. Appropriateness of DOAC dosing was assessed based on age (≥80 years), weight (≤60kg) and renal function (serum creatinine ≥133μmol/l [apixaban]; creatinine clearence ≤50ml/min [all other DOACs]). Clinical outcomes were collected during a median follow-up of 2.96 years. Major adverse clinical events (MACE) consisted of a combination of myocardial infarction, cardiac death, ischemic stroke and systemic embolism. Safety was assessed by occurrence of any bleeding event. Results 1902 patients (58%) were on VKAs and 1365 on DOACs (42%). In the DOAC group, 1149 patients received a dose consistent with drug labelling (84%), 133 (10%) received an inappropriately high and 83 (6%) an inappropriately low dose. Overdosed patients were older than those adequately treated and more likely female, had a lower BMI and a higher CHA2DS2-VASc score (4 vs. 3 points) (p Figure 1. Kaplan-Meier incidence curves Conclusion Inadequate DOACs dosing was found in 1 in 6 patients and correlated with a higher burden of comorbidities at baseline. Underdosing correlated with concomitant antiplatelet therapy. Overdosing was associated with adverse clinical outcome for ischemic and bleeding events. |
| تدمد: | 1522-9645 0195-668X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_________::7e0a0f6a6ab96008feaf3a0b0530f40cTest https://doi.org/10.1093/eurheartj/ehz748.0645Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi...........7e0a0f6a6ab96008feaf3a0b0530f40c |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15229645 0195668X |
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