Analysis of Oral Anticoagulant Dosing and Adherence to Therapy Among Patients With Nonvalvular Atrial Fibrillation
Why the study?
Although reduced DOAC doses are approved for patients with nonvalvular AF at high bleeding risk, little is known about dosing accuracy, particularly in renal dysfunction, or whether underdosing associates with longitudinal adherence.
Does underdosing of DOACs reduce 1-year adherence to therapy in patients with nonvalvular atrial fibrillation?
Population
86 919 patients with nonvalvular AF and CHA2DS2-VASc score of 2 or higher treated with DOACs
Comparison
DOAC underdosing and excess dosing vs appropriate dosing
Design
Retrospective cohort analysis
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
May inform dosing vigilance in renal impairment; leaves open whether underdosing causally affects adherence in NVAF.
Structured PICO
Does underdosing of DOACs reduce 1-year adherence to therapy in patients with nonvalvular atrial fibrillation?
P
Population
86,919 patients with nonvalvular atrial fibrillation (NVAF) and CHA2DS2-VASc scores of 2 or higher treated with direct oral anticoagulants (DOACs). Median age 74, 50.3% male, 94.8% White. US-based national claims database.
I
Intervention
Underdosed DOACs (dosing not consistent with FDA label recommendations)
C
Comparator
Appropriately dosed DOACs (consistent with FDA label recommendations)
O
Outcome
1-year adherence to anticoagulation and anticoagulation discontinuation
Off-label underdosing of DOACs is common in NVAF patients, particularly those with renal dysfunction, and is associated with significantly lower long-term adherence and higher discontinuation rates.
Cite This Study
Rymer et al. (2023) studied this question.