P384 APPROPRIATENESS OF PRESCRIBING DIRECT ORAL ANTICOAGULANTS IN THE REAL WORLD: THE ANMCO NATIONAL AUDIT INITIATIVES APPRO–FA EVO PROJECT

Abstract

Abstract Although direct oral anticoagulants (DOACs) have been in use for more than 10 years, their use in clinical practice does not always comply with established indications, especially in terms of dosage. With the National APPRO– FA EVO Audit Initiatives, data were collected on the use of DOACs in Italian hospital heart centres. In the present study, we analyse DOAC use based on the indications reported in the summary of product characteristics. Methods Aggregated data on patients discharged with a diagnosis of non–valvular atrial fibrillation (FANV) over a 2–week observation period were collected through a digital platform. Extrapolated variables included age, sex, diagnosis at discharge, presence of comorbidities, renal function (creatinine clearance, ClCr), and prescribed antithrombotic therapy. Results A total of 48 heart centres contributed to data collection. During the observation period, the total number of discharged patients was 1933. Among patients with a discharge diagnosis of FANV (569), 338 (59.4%) were male, 228 (40%) were >80 years old, and 228 (40%) had a ClCr between 15 and 50 ml/min). Patients with a diagnosis of FANV undergoing coronary angioplasty during hospitalization were 103 (18.1%), 112 (19.7%) with a diagnosis of acute coronary syndrome, and 232 (40.6%) of heart failure (Figure 1). There were 300 (52.7%) male patients with CHA2–DS2–VASc score ≥2 and 219 (38.5%) female patients with CHA2–DS2–VASc score ≥ 3. Among patients with FANV discharged on oral anticoagulant therapy (96,3%), 89.6% were on DOAC. The most frequently used DOAC was apixaban (35.5%), followed by rivaroxaban (25.2%), edoxaban (20.6%) and dabigatran (18.8%) (Figures 2 and 3). The use of reduced dosage met the reduction criteria in 90.2% of cases for apixaban, 90.9% for rivaroxaban, and 86.7% for edoxaban. Among patients treated with dabigatran, there was a higher prescription of the reduced dose than the full dose (10.2% vs 8.6%). Conclusions In accordance with international guidelines, DOACs are the anticoagulants of choice in most patients with FANV. Although the dosage used in clinical practice was found to be appropriate in about 90% of prescriptions, there is non–negligible room for the improvement of prescribing DOAC appropriateness.