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Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation.
- Source :
- European Journal of Clinical Pharmacology; May2022, Vol. 78 Issue 5, p879-886, 8p, 1 Diagram, 3 Charts, 1 Graph
- Publication Year :
- 2022
-
Abstract
- Purpose: Older 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. Methods: Data 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. Results: A 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). Conclusion: In 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- STATISTICS
ACADEMIC medical centers
ORAL drug administration
MULTIPLE regression analysis
LOG-rank test
ATRIAL fibrillation
ANTICOAGULANTS
ACQUISITION of data
RETROSPECTIVE studies
MANN Whitney U Test
INAPPROPRIATE prescribing (Medicine)
T-test (Statistics)
MEDICAL records
DESCRIPTIVE statistics
CHI-squared test
KAPLAN-Meier estimator
DISEASE prevalence
DATA analysis software
LONGITUDINAL method
OLD age
Subjects
Details
- Language :
- English
- ISSN :
- 00316970
- Volume :
- 78
- Issue :
- 5
- Database :
- Complementary Index
- Journal :
- European Journal of Clinical Pharmacology
- Publication Type :
- Academic Journal
- Accession number :
- 156297446
- Full Text :
- https://doi.org/10.1007/s00228-022-03286-2