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Inappropriate doses of direct oral anticoagulants in real-world clinical practice: prevalence and associated factors. A subanalysis of the FANTASIIA Registry

2017; Oxford University Press; Volume: 20; Issue: 10 Linguagem: Inglês

10.1093/europace/eux316

1532-2092

Martín Ruiz Ortiz, Javier Muñiz, P Rana Miguez, Inmaculada Roldán, Francisco Marı́n, María Asunción Esteve‐Pastor, Ángel Cequier, Manuel Martínez‐Sellés, Vicente Bertoméu, Manuel Anguita, Manuel Almendro, Luis Alonso‐Pulpón, Jorge Duerto, Ignasi Anguera, Manuel Anguita, Jorge Arnulfo, Alfredo Bardajı́, Gonzalo Barón‐Esquivias, Antoni Bayés‐Genís, Neus Bellera, Vicente Bertomeu G., J L Bonilla, Vicens Brossa, Francisco Buendía Fuentes, José Camacho, Teresa Rodríguez Cano, M.A. Martı́nez, J García Casas, Juan C. Castillo, Marta Ma Cobo, Inmaculada Coca, Ingrid Colomer, Josep Comín, Luis Cornide, Juan Cosín, Manuel Crespín Crespín, Pedro Chinchurreta, David Chivite, Tomás Datino, Ramón de Castro, José Gonzalo Delgado, Mónica Delgado, Mar Domingo, Paloma Elviro, Carlos Escobar, Esther Esteban, Fátima Esteban, António Fernández, Andrés López Fernández, Enrique Galve, José María Gámez Martínez, Antonio Luis Gámez, Daniel García, Ana Maria Garcı́a, María Laura García, Lorena García, Miguel García, Pablo García‐Pavía, Francisco J. García‐García, M. Carmen Gil, Diego Giménez, J.J. Gávira Gómez, Sílvia Gómez, Carlos M. Travieso, Manuel Gonzálvez, Jesús Manuel Hernández, Rafael Hidalgo, Cristina Jiménez, Javier Jiménez, José Luis Lambert, Manuel Penas Lado, Mariano Leal, Antonio Lillo, Laura López, José A. Madrigal, Nicolás Manito, Sergio Manzano, Dolores Julia Yusá Marco, Francisco Marín‐Ortuño, Manuel Martínez‐Sellés, Marta Mateos, Rodrigo Mayo, Pilar Mazón, Jose A Niño Medina, Javier Martínez Mesa, Sònia Mirabet, Ma Victoria Mogollón, José Manuel Moreno Villares, Nekane Murga, Juana Núñez, Carmen Olmos, Imanol Otaegui, Jaume Francisco‐Pascual, Rafael Payá, Alejandro Pérez, J. Serna Pérez, José Carlos Rodríguez Pérez, José Carlos Rodríguez Pérez, R Cabrera Pérez, Neus Piulats, Yolanda Porras, Antonio Pose, M. Angustias Quesada, Raúl Quirós López, Esther Recalde, Francisco Ridocci, Tomás Ripoll, Marcos Rodríguez, Eulàlia Roig, Inmaculada Roldán, Elías Romo, J.M. Rubio Campal, Martín Ruiz Ortiz, Carmen Rus, Daniel Salas, Pepa Sánchez, Axel Sarrias, Isabel Serrano, César Sosa, M. Roza Suarez, Francisco Torres, Joan Segura Torres, Alfonso Varela, Eduardo Vázquez, María Teresa Vidán, Isidre Vilacosta, Elena Villanueva, Roger Villuendas, David Vivas,

Venous Thromboembolism Diagnosis and Management

To describe the prevalence and associated factors of inappropriate doses of direct oral anticoagulants (DOAC) in a national registry of patients of real clinical practice.Five hundred and thirty outpatients with atrial fibrillation treated with DOAC were included in a prospective, national, multicentre study. The appropriateness of the doses of DOAC was defined according to the recommendations of the European Heart Rhythm Association. Mean age was 73 ± 9 years, with a 46% of women. Two hundred and sixty-seven patients were prescribed dabigatran, 190 rivaroxaban, and 73 apixaban. A total of 172 patients (32%) did not receive the appropriate dose: 93 patients received a lower dose (18%) and 79 patients a higher dose (15%). In the comparisons among the subgroups of inappropriately low, appropriate, and inappropriately high dose, we observed significant trends to older age (69 ± 8 years vs. 73 ± 10 years vs. 77 ± 6 years), more frequent female sex (37% vs. 46% vs. 59%), antiplatelet drugs (5% vs. 8% vs. 25%), rivaroxaban (14% vs. 38% vs. 53%), and apixaban use (5% vs. 15% vs. 19%), higher CHAD2DS2-VASc (3.00 ± 1.38 vs. 3.58 ± 1.67 vs. 4.59 ± 1.44) and HAS-BLED scores (1.83 ± 0.87 vs. 1.92 ± 1.07 vs. 2.47 ± 1.13), lower body mass index (30 ± 6 kg/m2 vs. 29 ± 4 kg/m2 vs. 28 ± 4 kg/m2) and glomerular filtration rate (74 ± 27 mL/min vs. 70 ± 22 mL/min vs. 63 ± 16 mL/min), and lower frequency of dabigatran use (81% vs. 47% vs. 28%) (all comparisons P ≤ 0.01).In this real-life study, 32% of patients received an inappropriate dose of DOAC. Several clinical factors can identify patients at risk of this situation.