Abstract
PurposeOlder age is associated with inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting.MethodsData for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). Of the AF patients aged ≥ 80 who received DOACs treatment, 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were, respectively, defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus.ResultsA total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them, 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR = 3.15 (95% IC; 1.45–6.83); p < 0.001], coronary artery disease [OR = 3.60 (95% IC 1.45–9.10); p < 0.001] and body mass index [OR = 1.27 (1.14–1.41); p < 0.001]. Overdosage was independently associated with diabetes mellitus [OR = 18 (3.36–96); p < 0.001], with age [OR = 0.76 (95% IC; 0.61–0.96; p = 0.045], BMI [OR = 0.77 (95% IC; 0.62–0.97; p = 0.043] and with previous bleedings [OR = 6.40 (0.7; 1.43–28); p = 0.039]. There wasn’t significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p < 0.001).ConclusionIn our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors were associated with DOACs’ overdosage (diabetes mellitus type II, previous bleeding) or underdosage (male gender, coronary artery disease, and higher body mass index). Octogenarians with inappropriate DOACs underdosage showed less survival.
Highlights
Direct oral anticoagulants (DOACs) are recommended in preference to VKAs for the stroke prevention in atrial fibrillation (AF) patients eligible for oral anticoagulation therapy [1], based on their favorable risk–benefit profile regardless of the patients’ age [2, 3]
Demographic and clinical characteristics of the population are showed in Table 1. 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.60%) were overdosed and 56 (74.40%) were underdosed
Permanent AF occurred in a lower percentage of patients with inappropriate dosing compared to appropriate dosing (44% vs 65%; p < 0.001); as did acetyl salicylic acid combination (4% vs 15.70%; p = 0.009), compared with appropriate dose group (Table 1)
Summary
Direct oral anticoagulants (DOACs) are recommended in preference to VKAs for the stroke prevention in atrial fibrillation (AF) patients eligible for oral anticoagulation therapy [1], based on their favorable risk–benefit profile regardless of the patients’ age [2, 3]. DOACs showed higher net clinical benefit versus VKAs in octogenarians with AF both in trial [4,5,6,7] and in real-world setting [8, 9]. Data about the clinical factors associated to inappropriate dose prescription of DOACs, both under and overdosage,. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in realworld setting
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