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

Bezabhe, WM ORCID: 0000-0002-3028-6949, Bereznicki, LR ORCID: 0000-0003-3974-3437, Radford, J ORCID: 0000-0002-5751-0488, Wimmer, BC ORCID: 0000-0003-3166-7126, Salahudeen, MS ORCID: 0000-0001-9131-7465 and Peterson, GM ORCID: 0000-0002-6764-3882 2021 , '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 , doi: https://doi.org/10.1097/PTS.0000000000000924.

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Abstract

Objective: Concerns have been raised over the appropriateness of dosingof direct-acting oral anticoagulants (DOACs) in clinical practice. We investigated this issue in patients who were initiated on a DOAC in Australiangeneral practices.Methods:This was a retrospective study among patients newly diagnosedwith atrial fibrillation (AF) who were prescribed DOACs, using data obtainedfrom 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) newlydiagnosed with AF were prescribed a DOAC. Of these, 2667 patients(23.7%) had a recorded prescription of a potentially inappropriate DOACdosage, of whom 2304 (86.4%) and 283 (10.6%) were prescribed lowerand higher than the recommended dosage, respectively. The remaining 80patients (3.0%) were initiated on DOACs when contraindicated based on renal function. Overall, the proportion of patients who seemed to be initiated ona 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 Conclusions: Potential inappropriate DOAC dosing is a problem in theprevention of stroke associated with AF. Nearly 1 in 5 patients received alower-than-guideline-recommended dose, indicating a need for strategiesto raise awareness among prescribers.

Item Type: Article
Authors/Creators:Bezabhe, WM and Bereznicki, LR and Radford, J and Wimmer, BC and Salahudeen, MS and Peterson, GM
Keywords: dosing errors, anticoagulation, oral anticoagulants, chronic kidney disease, atrial fibrillation, primary care
Journal or Publication Title: Journal of Patient Safety
Publisher: Lippincott Williams & Wilkins
ISSN: 1549-8417
DOI / ID Number: https://doi.org/10.1097/PTS.0000000000000924
Copyright Information:

Copyright © 2021 Lippincott Williams & Wilkins

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