Key result
Inappropriate DOAC dosing affects ~28% of patients, linked to older age and creatinine clearance.
Why the study?
Recent audits revealed a significant burden of inappropriate DOAC dosing, prompting an evaluation of its prevalence and predictors in clinical practice.
What is the prevalence and what are the predictors of inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation or venous thromboembolism?
Observational (n=337)
What is the prevalence and what are the predictors of inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation or venous thromboembolism?
Odds Ratio: 2.76 (95% CI 1.67–4.56)
p-value: p=<0.001
Nearly one-third of patients receiving DOACs for AF or VTE are inappropriately dosed (primarily underdosed), which is associated with increased mortality and predicted by older age and lower creatinine clearance.
Hypothesis-generating for dosing interventions targeting elderly DOAC users; prospective studies needed before clinical adoption.
Direct-Acting Oral Anticoagulants (DOACs) have revolutionized the management of Atrial Fibrillation (AF) and Venous Thromboembolism (VTE). However, recent audits reveal a significant burden of inappropriate dosages in the prescribing of direct-acting oral anticoagulants. Our aim is to identify the prevalence and predictors of such inappropriate dosing in our patients. This retrospective study was conducted from June 2016 to January 2018. Patients who received dabigatran, rivaroxaban, or apixaban for treatment of venous thromboembolism or atrial fibrillation were included. Appropriateness of direct-acting oral anticoagulants dosing was assessed using US Food and Drug Administration guidelines. Data was analyzed using IBM® SPSS Version 26. 337 patients were included, with a mean age of 62.9±18.7 years. The majority were female (196, 58.3%). Of the patients, 194 (57.6%) received apixaban, 99 (29.4%) received rivaroxaban, and 44 (13.1%) received dabigatran. A total of 242 (71.8%) patients were prescribed direct-acting oral anticoagulants appropriately. Under-dosing and over-dosing were identified in 74 (22%) and 21 (6.2%) patients, respectively. Predictors of inappropriate dosing were age greater than 75 years (OR: 2.76, 95% CI: 1.67-4.56, p<0.001) and creatinine clearance less than 50 ml/minute (OR: 0.38, 95% CI: 0.19-0.74, p: 0.005). Inappropriate dosing was significantly associated with mortality (p=0.010).One-third of our patients received an inappropriate dose of direct-acting oral anticoagulants, mostly from underdosing. Elderly age and low creatinine clearance are significant predictors of inappropriate dose administration.
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Mosaad Almegren (2024) conducted an observational in Venous thromboembolism or atrial fibrillation (n=337). Direct-acting oral anticoagulants (DOACs) was evaluated on Inappropriate dosing (OR 2.76, 95% CI 1.67-4.56, p=<0.001). Inappropriate dosing of DOACs occurred in 28.2% of patients, with age >75 years (OR 2.76; 95% CI 1.67-4.56) and creatinine clearance <50 ml/min (OR 0.38; 95% CI 0.19-0.74) as significant predictors.
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