Direct Oral Anticoagulant (DOAC) Dosing in Patients with Non-valvular Atrial Fibrillation (NVAF) in the United Kingdom: A Retrospective Cohort Study Using CPRD Gold Database

被引:5
作者
Khachatryan, Artak [1 ]
Doobaree, Indraraj Umesh [1 ]
Spentzouris, George [2 ]
Gusto, Gaelle [3 ]
Zawaneh, Yousef [1 ]
Mughal, Farhan [4 ]
Anastassopoulou, Anastassia [2 ]
Manu, Marius [2 ]
Fay, Matthew [5 ,6 ]
机构
[1] Certara, Evidence & Access, London, England
[2] Daiichi Sankyo Europe, Munich, Germany
[3] Certara, Evidence & Access, Paris, France
[4] Daiichi Sankyo UK, Uxbridge, Middx, England
[5] Univ Warwick, Warwick Med Sch, Warwick, England
[6] Willows Med Practice, Bradford, W Yorkshire, England
关键词
Atrial fibrillation; Anticoagulants; Stroke prevention and control; United Kingdom; Apixaban; Dabigatran; Edoxaban; Rivaroxaban; CPRD; WARFARIN; RISK;
D O I
10.1007/s12325-022-02368-y
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
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%; similar to 2% had prior major bleed and 4.4% a stroke <= 2 years before DOAC initiation. Overall, 18.0% of patients received incorrect dosing (similar to 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, similar to one in five patients was incorrectly dosed with DOAC, which may lead to serious clinical consequences and increased healthcare burden.
引用
收藏
页码:504 / 520
页数:17
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