Key result
DOACs are prescribed inappropriately to ~39% of primary care AF patients, driven mostly by under-dosing.
Why the study?
Inappropriate DOAC dosing is common in NVAF, but conflicting results have been reported regarding the factors independently associated with it.
What factors are associated with inappropriate DOAC dosing in primary care patients with non-valvular atrial fibrillation?
Cross-Sectional (n=1,111)
Yes
What factors are associated with inappropriate DOAC dosing in primary care patients with non-valvular atrial fibrillation?
Inappropriate DOAC prescribing is common in primary care, particularly under-dosing in older patients and those with higher stroke risk, and over-dosing in those with kidney failure or high bleeding risk.
Signals need for DOAC dosing reviews in primary care; leaves open effective interventions to reduce inappropriate prescriptions.
BACKGROUND: Direct oral anticoagulants (DOACs) account for an increasing proportion of prescriptions in patients with non-valvular atrial fibrillation (NVAF) in primary care. Inappropriate dosing of DOACs is a common problem, with under-dosing being a particular issue. However, conflicting results have been reported about the factors independently associated with inappropriate dosing. AIM: To describe inappropriate prescriptions of DOACs among patients in the CACAO French nationwide general practice cohort, and to identify the factors independently associated with inappropriate DOAC doses. DESIGN AND SETTING: Cross-sectional baseline analysis of the CACAO French national multicentre prospective cohort of adult patients in primary care receiving an oral anticoagulant who were recruited between April and October 2014. METHOD: A total of 1111 patients from the CACAO cohort who received a DOAC for NVAF were included in this study. Inappropriate prescriptions of DOACs were described (inappropriate dosage, contraindications, non-indications, interactions, and non-compliance with the precautions for use). Multivariate logistic models were used to investigate factors associated with inappropriate DOAC dosing (under-dosing and over-dosing). RESULTS: = 348, 31.3%). Multivariate analysis revealed that factors independently associated with under-dosing were older age, prescription of apixaban or dabigatran, and a CHA2DS2-VASc score ≥2 vs. a score = 1. Factors with over-dosing were kidney failure, a HAS-BLED score ≥3, and older age. CONCLUSION: The appropriateness of DOAC prescribing for NVAF can be improved, especially in older patients, and in patients with kidney failure, a higher risk of ischaemic stroke, and/or a higher risk of bleeding. GPs have a key role in increasing the proportion of appropriate DOAC prescriptions via informational, educational, and/or management strategies.
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Ferrat et al. (2020) conducted a cross-sectional in Non-valvular atrial fibrillation (n=1,111). Direct oral anticoagulants (DOACs) was evaluated on Inappropriate DOAC prescription. In a French primary care cohort, 39.4% of patients with non-valvular atrial fibrillation received at least one inappropriate direct oral anticoagulant prescription, most commonly under-dosing (31.3%).
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