Real-world study of direct oral anticoagulant dosing patterns in patients with atrial fibrillation
Pharm. pract. (Granada, Internet)
; 17(4): 0-0, oct.-dic. 2019. tab
Artigo
em Inglês
| IBECS
| ID: ibc-191967
Biblioteca responsável:
ES1.1
Localização: BNCS
ABSTRACT
BACKGROUND:
Direct oral anticoagulants (DOACs) are preferred for stroke prevention in atrial fibrillation (AF). However, off-label doses have been associated with increased risk of adverse events.OBJECTIVE:
The objective of this study was to compare the frequency and outcomes of labeled versus off-label DOAC dosing in patients with AF.METHODS:
This retrospective cohort study included adults diagnosed with nonvalvular AF (NVAF), discharged from University of Utah Health on DOAC therapy between 7/1/2017 and 9/30/2017. The primary outcome was off-label DOAC dosing frequency, defined as dosing inconsistent with manufacturer labeling. Secondary outcomes included variables associated with off-label dosing and a composite of adverse events (major bleeding, thromboembolism, and all-cause mortality) in the 90 days following the index hospital discharge.RESULTS:
Of 249 included patients, 16.1% were discharged with off-label dosing. Factors associated with off-label dosing included advanced age, lower body mass index, decreased renal function, use of rivaroxaban, and hepatic impairment. The majority of off-label patients (70%) received lower-than-recommended DOAC dosing. Prescriber rationale for off-label prescribing was documented in 25% of patients and included anti-Xa guided dosing, high risk for bleeding or thromboembolism, and prior history of on-therapy adverse events. The rate of adverse events between labeled and off-label DOAC doses was not statistically different (10.0% vs.6.7%, p = 0.299), although this is likely due to small sample size.CONCLUSIONS:
Off-label DOAC prescribing for stroke prevention in NVAF at University of Utah Health was consistent or lower than previously published studies. Off-label dosing most often involved under-dosing of rivaroxaban. Future research should investigate the role of provider rationale and insight in optimizing DOAC therapyoutcomes:
RESUMEN
No disponible
Texto completo:
Disponível
Coleções:
Bases de dados nacionais
/
Espanha
Base de dados:
IBECS
Assunto principal:
Fibrilação Atrial
/
Tromboembolia
/
Acidente Vascular Cerebral
/
Anticoagulantes
Limite:
Idoso
/
Feminino
/
Humanos
/
Masculino
Idioma:
Inglês
Revista:
Pharm. pract. (Granada, Internet)
Ano de publicação:
2019
Tipo de documento:
Artigo
Instituição/País de afiliação:
University of Utah Health/United States
/
University of Utah/United States