Bezabhe, WM and Bereznicki, LR and Radford, J and Wimmer, BC and Salahudeen, MS and Peterson, GM, Eight-year trends in direct-acting oral anticoagulant dosing, based on age and kidney function, in patients with atrial fibrillation, Journal of Patient Safety pp. 1-5. ISSN 1549-8417 (2021) [Refereed Article]
Copyright © 2021 Lippincott Williams & Wilkins
Objective: Concerns have been raised over the appropriateness of dosing of direct-acting oral anticoagulants (DOACs) in clinical practice. We investigated this issue in patients who were initiated on a DOAC in Australian general practices.
Methods:This was a retrospective study among patients newly diagnosed with atrial fibrillation (AF) who were prescribed DOACs, using data obtained from 417 general practice sites across Australia over 8 years (2011–2019). Direct-acting oral anticoagulant dosing was compared with published recommendations, in relation to age and kidney function.
Results: A total of 11,251 patients (mean age, 72.8 y; 46.8% female) newly diagnosed with AF were prescribed a DOAC. Of these, 2667 patients (23.7%) had a recorded prescription of a potentially inappropriate DOAC dosage, of whom 2304 (86.4%) and 283 (10.6%) were prescribed lower and higher than the recommended dosage, respectively. The remaining 80 patients (3.0%) were initiated on DOACs when contraindicated based on renal function. Overall, the proportion of patients who seemed to be initiated on a potentially inappropriate DOAC dose decreased from 38.3% (95% confidence interval, 26.1%–51.8%) in 2012 to 22.7% (95% confidence interval, 19.8%–26.0%; P < 0.001) in 2019. By 2019, 19.4%, 20.3%, and 9.3% of the patients with a recorded prescription of apixaban, rivaroxaban, and dabigatran, respectively, received a lower-than-guideline-recommended dose. The patients were more likely to be prescribed a potentially inappropriate dosage if they were elderly with multiple comorbidities.
Conclusions: Potential inappropriate DOAC dosing is a problem in the prevention of stroke associated with AF. Nearly 1 in 5 patients received a lower-than-guideline-recommended dose, indicating a need for strategies to raise awareness among prescribers.
|Item Type:||Refereed Article|
|Keywords:||dosing errors, anticoagulation, oral anticoagulants, chronic kidney disease, atrial fibrillation, primary care|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Pharmacology and pharmaceutical sciences|
|Research Field:||Clinical pharmacy and pharmacy practice|
|Objective Group:||Evaluation of health and support services|
|Objective Field:||Evaluation of health outcomes|
|UTAS Author:||Bezabhe, WM (Dr Woldesellassie Bezabhe)|
|UTAS Author:||Bereznicki, LR (Professor Luke Bereznicki)|
|UTAS Author:||Radford, J (Professor Jan Radford)|
|UTAS Author:||Wimmer, BC (Dr Barbara Wimmer)|
|UTAS Author:||Salahudeen, MS (Dr Mohammed Salahudeen)|
|UTAS Author:||Peterson, GM (Professor Gregory Peterson)|
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