Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and has been one of the most studied disease in the world for the last 20 years. As it is a frequent cause of preventable strokes, substantial research efforts were directed toward gaining detailed information about effective prophylactic treatments. New evidence has been continuously published and resulted in the approval of direct-acting oral anticoagulants (DOACs) in this scenario, which are safer and easier to use than vitamin K antagonists (VKA) [ [1] Hindricks G. Potpara T. Dagres N. et al. ESC scientific document group, 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC. Eur. Heart J. 2021; 42: 373-498https://doi.org/10.1093/eurheartj/ehaa612 Crossref PubMed Scopus (2515) Google Scholar ]. Although the randomized clinical trials that substantiated the approval of DOACs were based in well-designed protocols with a clear description of the target population under stroke and thromboembolic risk and well stablished DOAC doses, patients in real world are often undertreated relative to treatment recommendations, in large part based on physicians' fear of bleeding events [ [2] Steinberg B.A. Shrader P. Thomas L. et al. Off-label dosing of non-vitamin K antagonist oral anticoagulants and adverse outcomes: the ORBIT-AF II Registry. J. Am. Coll. Cardiol. 2016; 68: 2597-2604https://doi.org/10.1016/j.jacc.2016.09.966 Crossref PubMed Scopus (304) Google Scholar ]. Furthermore, selecting the preferable DOAC in an appropriate dose can be challenging in clinical practice once all DOACs (dabigatran, rivaroxaban, apixaban and edoxaban) have different doses and specific dose reduction criteria that depend upon several patient specific factors such as age, body weight, renal function and/or concomitant medications. This may result in around one fifth of patients receiving inappropriate DOAC dosing according to the drug label [ [3] Capiau A. De Backer T. Grymonprez M. et al. Appropriateness of direct oral anticoagulant dosing in patients with atrial fibrillation according to the drug labelling and EHRA practical guide. Int. J. Cardiol. 2021; 328: 97-103https://doi.org/10.1016/j.ijcard.2020.11.062 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ]. In addition to underdoses prescription, patients´ non-adherence to oral anticoagulants may significantly increase the overall healthcare costs, due to higher risk of thromboembolic events. When added, prescribers insecurity regarding bleeding events and factors such as patients age, gender and drug posology may have great impact on efficacy outcomes in patients with AF who need chronic anticoagulation [ [4] Barcellona D. Mameli A. Cornacchini S. et al. Patients’ adherence to oral anticoagulants therapy: comparison between vitamin K antagonists and direct oral anticoagulants. Int. J. Cardiol. 2021; 333: 162-166https://doi.org/10.1016/j.ijcard.2021.03.003 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ]. Clinical effects of off-label reduced doses of Direct Oral Anticoagulants: A systematic review and meta-analysisInternational Journal of CardiologyVol. 362PreviewAtrial Fibrillation (AF) is the most prevalent cardiac arrhythmia among older patients, associated with thromboembolic events. Direct Oral Anticoagulants (DOAC) are the treatment of choice for most patients, but its use may have risks on standard dose. However, it is still unclear the effects related with the use of a lower dose off labelled DOAC. Full-Text PDF
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call