Key result
In a retrospective cohort of NVAF patients, 31.3% received an inappropriately reduced dose of dabigatran (110 mg), with increasing age significantly associated with underdosing (OR 1.02).
Why the study?
Proper dabigatran dosing is critical to balance thromboprophylactic benefit and safety, but establishing appropriate thromboembolism prevention remains a challenge.
What is the rate of inappropriate dabigatran dosing in patients with nonvalvular atrial fibrillation?
Cohort (n=151)
No
What is the rate of inappropriate dabigatran dosing in patients with nonvalvular atrial fibrillation?
Odds Ratio: 1.02 (95% CI 0.014–0.03)
p-value: p=<0.001
A significant proportion of NVAF patients receive inappropriately reduced doses of dabigatran, primarily driven by older age, highlighting a need for improved prescriber education.
Frequent inappropriate dabigatran underdosing in NVAF, especially with advancing age, warrants prescribing vigilance; leaves open outcome effects in observational cohorts.
BACKGROUND: Establishment of thromboembolism prevention remains a challenge despite the widespread consensus that thromboprophylaxis safely reduces patient morbidity and mortality. Dabigatran is a nonvitamin K antagonist oral anticoagulant (NOAC) which reduces the risk of thromboembolism. Proper dosing is important to achieve the maximum prophylactic benefit with a maintained safety profile. OBJECTIVE: To evaluate the appropriateness of dabigatran dosing for stroke and systemic embolism prevention in patients with nonvalvular atrial fibrillation (NVAF). METHODS: This is a retrospective cohort study of adults with NVAF. The data were collected from the electronic filing system of the hospital. Patients receiving dabigatran therapy were divided into two treatment groups according to the dose of dabigatran received. The indications for dabigatran as an oral direct anticoagulant, including age, risk of bleeding, creatinine clearance (CrCl), were collected. Appropriateness of dose reduction included any of the following factors: HAS-BLED score >2 points, age ≥75 years, or CrCl of 30-50 mL/min. The two groups were evaluated according to dose appropriateness. CONCLUSION: This study revealed inappropriate prescription of reduced doses of dabigatran in a large number of patients. Age was identified as the main driving factor for underdosing. Physicians' and pharmacists' awareness regarding this type of high-risk medication should be improved to ensure appropriate and safe use of this commonly used drug.
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Alali et al. (2019) conducted a cohort in Nonvalvular atrial fibrillation (NVAF) (n=151). Dabigatran vs. Appropriate vs inappropriate dosing was evaluated on Inappropriate dose reduction of dabigatran (110 mg) and association with age (OR 1.02, 95% CI 0.014-0.03, p=<0.001). In a retrospective cohort of NVAF patients, 31.3% received an inappropriately reduced dose of dabigatran (110 mg), with increasing age significantly associated with underdosing (OR 1.02).
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