eCite Digital Repository

Eight-year trends in direct-acting oral anticoagulant dosing, based on age and kidney function, in patients with atrial fibrillation


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 Statement

Copyright 2021 Lippincott Williams & Wilkins

DOI: doi:10.1097/PTS.0000000000000924


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 (20112019). 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 Details

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 Division:Health
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)
ID Code:147510
Year Published:2021
Deposited By:Pharmacy
Deposited On:2021-11-05
Last Modified:2021-12-20

Repository Staff Only: item control page