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Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK.
García Rodríguez, Luis Alberto; Martín-Pérez, Mar; Vora, Pareen; Roberts, Luke; Balabanova, Yanina; Brobert, Gunnar; Fatoba, Samuel; Suzart-Woischnik, Kiliana; Schaefer, Bernhard; Ruigomez, Ana.
Afiliação
  • García Rodríguez LA; Pharmacoepidemiology, Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain lagarcia@ceife.es.
  • Martín-Pérez M; Pharmacoepidemiology, Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain.
  • Vora P; Epidemiology, Bayer AG, Berlin, Germany.
  • Roberts L; Study Medical Experts, Bayer PLC, Reading, UK.
  • Balabanova Y; Epidemiology, Bayer AG, Berlin, Germany.
  • Brobert G; Epidemiology, Bayer AB, Stockholm, Sweden.
  • Fatoba S; Medical Affairs, Bayer PLC, Reading, UK.
  • Suzart-Woischnik K; Epidemiology, Bayer AG, Berlin, Germany.
  • Schaefer B; Epidemiology, Bayer AG, Berlin, Germany.
  • Ruigomez A; Pharmacoepidemiology, Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain.
BMJ Open ; 9(9): e031341, 2019 09 20.
Article em En | MEDLINE | ID: mdl-31542760
ABSTRACT

OBJECTIVE:

To evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulants (NOACs) according to label in patients with non-valvular atrial fibrillation (NVAF) in the UK.

DESIGN:

Population-based cross-sectional study.

SETTING:

UK primary care. POPULATION 30 467 patients with NVAF and a first prescription for apixaban, dabigatran or rivaroxaban between January 2011 and December 2016. MAIN OUTCOME

MEASURES:

Percentage of patients prescribed a NOAC dose according to the European Union (EU) labels (appropriately dosed), and not according to the EU labels (inappropriately dosed-including both underdosed and overdosed patients); percentage of patients prescribed an initial NOAC dose according to renal function status.

RESULTS:

A total of 15 252 (50.1%) patients started NOAC therapy on rivaroxaban, 10 834 (35.6%) on apixaban and 4381 (14.4%) on dabigatran. Among patients starting NOAC therapy on rivaroxaban, 17.3% were eligible to receive a reduced dose compared with 12.8% of patients starting on apixaban and 53.8% of patients starting on dabigatran. The majority of patients were prescribed an appropriate dose according to the EU labels apixaban 74.9 %, dabigatran, 74.4%; rivaroxaban, 84.2%. Underdosing occurred in 21.6% (apixaban), 8.7% (dabigatran), 9.1% (rivaroxaban). Overdosing was more frequent for dabigatran (16.9%) than for rivaroxaban (6.6%) or apixaban (3.5%). There was a trend towards dose reduction with increasing renal impairment. Among patients with severe renal impairment, the majority received a reduced dose NOAC apixaban, 91.1%, dabigatran, 80.0%, rivaroxaban, 83.0%.

CONCLUSION:

Between 2011 and 2016, the majority of patients starting NOAC therapy in UK primary care were prescribed a daily dose in line with the approved EU drug label. Underdosing was more than twice as common among patients starting on apixaban than those starting on dabigatran or rivaroxaban. Research into the patient characteristics that may influence inappropriate underdosing of NOACs in UK primary care is warranted.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pirazóis / Piridonas / Fibrilação Atrial / Acidente Vascular Cerebral / Rivaroxabana / Dabigatrana / Anticoagulantes Tipo de estudo: Observational_studies / Prevalence_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pirazóis / Piridonas / Fibrilação Atrial / Acidente Vascular Cerebral / Rivaroxabana / Dabigatrana / Anticoagulantes Tipo de estudo: Observational_studies / Prevalence_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2019 Tipo de documento: Article