Among older hospitalized patients with atrial fibrillation, 33% were prescribed DOACs at discharge, with 31% of these prescriptions violating smPC criteria, primarily due to underdosage (17%).
Cohort (n=609)
Yes
DOAC prescribing in older, frail inpatients with atrial fibrillation is suboptimal, characterized by frequent underdosing and missed prescriptions often driven by unwarranted concerns over bleeding risk.
AIMS: Knowledge on the prescriptive practice of direct oral anticoagulants (DOACs) in older subjects with atrial fibrillation (AF) hospitalized in acute medical wards is limited. This study aimed to evaluate the prevalence and appropriateness of DOAC prescriptions in hospitalized older subjects with AF, discharged from acute medical wards. METHODS: We analysed a cohort of 609 subjects with AF, aged ≥65 years (mean age 85 years) enrolled from 39 geriatric and nephrology wards in Italy. DOAC prescriptive appropriateness was evaluated according to the summary of product characteristics (smPC), 2019 Beers and STOPP criteria, and drug-drug interactions (DDIs). RESULTS: At hospital discharge, 33% of patients with AF were prescribed with DOAC, 26% with vitamin-K antagonist, while 41% did not receive any anticoagulant. Among subjects on DOAC therapy, 31% presented a violation of the smPC criteria (mainly underdosage-17%), while 48% and 18% presented a Beers/STOPP inappropriate prescription, or a DDI, respectively. Older age, lower body mass index (BMI), cancer and higher estimated glomerular filtration rate (eGFR) were independently associated with DOAC underdosage or missed prescription (age: adjusted odds ratio aOR 1.06, 95% confidence interval 95% CI 1.00-1.12 for underdosage; eGFR: aOR 1.04, 95% CI 1.02-1.07 for underdosage; BMI: aOR 0.95, 95% CI 0.91-0.99 for missed prescription; cancer: aOR 1.93, 95% CI 1.19-3.13 for missed prescription). CONCLUSIONS: This study showed a suboptimal DOAC prescriptive practice in older in-patients, with frequent missed prescription and DOAC underdosage. Contrary to current recommendations, physicians appear overly concerned by bleeding risk in real-life older and frailer subjects. Strategies should be developed to promote appropriate DOAC prescription in the hospital setting.
Vincentis et al. (Tue,) conducted a cohort in atrial fibrillation (n=609). Direct oral anticoagulants (DOACs) vs. Vitamin-K antagonist or no anticoagulant was evaluated on Prevalence and appropriateness of DOAC prescriptions. Among older hospitalized patients with atrial fibrillation, 33% were prescribed DOACs at discharge, with 31% of these prescriptions violating smPC criteria, primarily due to underdosage (17%).