Key result
Among Canadian patients with atrial fibrillation, 89% received guideline-directed antithrombotic therapy, but 32% of those receiving DOACs had dosing that was discordant with clinical guidelines.
Why the study?
The rate of NOAC dosing that is lower- or higher-than-recommended and the reasons for dose discordance with Health Canada prescribing information in Canadian AF patients were not well characterized.
Cross-Sectional (n=3,043)
Yes
Answers are grounded in this paper and cite their sources.
Frequent DOAC dosing discordance signals a quality gap in Canadian AF care; extends registry data but leaves open effects on outcomes.
AIMS: To estimate the rate of non-vitamin K oral anticoagulant (NOAC) dosing that is lower- and higher-than-recommended and to describe the reasons for NOAC dose discordance with Health Canada prescribing information. METHODS: The OPTIMAL AF Programme was an observational cohort quality assessment initiative in which primary and specialty care physicians in eight provinces provided a snapshot of their anticoagulated non-valvular atrial fibrillation (NVAF) patients through either an electronic medical record (EMR) system or standardised, paper-based data collection methods. RESULTS: Data on 1681 NVAF patients receiving oral anticoagulation (OAC) for stroke prevention was provided by 102 physicians. A NOAC was prescribed in 1379 patients (8%). The standard recommended dose was prescribed in 849 (76%) and reduced dose in 264 (24%). Concordance of the reduced dose with Health Canada prescribing information occurred in 154 patients (58%). The standard dose was concordant in 805 (95%). The main reasons for the use of discordant reduced doses were age of 80 years or more, elevated creatinine, prior bleeding or dose recommended by specialist. DISCUSSION AND CONCLUSION: The vast majority of Canadian patients meeting the Canadian Cardiovascular Society (CCS) guideline recommendations for OAC to decrease AF-related stroke risk were receiving product monograph-concordant NOAC dosing (85%). Nonetheless, this highlights the fact that an important proportion of patients were prescribed doses that are discordant and opportunities remain to improve NOAC dosing to optimise stroke prevention.
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Leblanc et al. (2020) conducted a cross-sectional in Nonvalvular Atrial Fibrillation (n=3,043). Direct oral anticoagulant (DOAC) therapy vs. Unexposed/Non-guideline directed therapy was evaluated on Point prevalence of CCS guideline-directed antithrombotic therapy. Among Canadian patients with atrial fibrillation, 89% received guideline-directed antithrombotic therapy, but 32% of those receiving DOACs had dosing that was discordant with clinical guidelines.
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