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. 2023 Oct 5;25(10):euad302.
doi: 10.1093/europace/euad302.

Characteristics of patients with atrial fibrillation treated with direct oral anticoagulants and new insights into inappropriate dosing: results from the French National Prospective Registry: PAFF

Maxime Guenoun  1   2 , Serge Cohen  2 , Marc Villaceque  3 , Ali Sharareh  2 , Jerome Schwartz  2 , Olivier Hoffman  2 , Jean-Claude Dib  4 , Leon Ouazana  2 , Serge Assouline  2 , Eric Parrens  2   5 , Thierry Garban  2 , Vincent Pradeau  2 , Dominique Guedj-Meynier  2 , Benoit Lequeux  2 , Charlotte Cohen  2 , Philippe Durand  2   6 , Francois Dievart  2 , Tarvinder S Dhanjal  7 , Pierre Sabouret  2   8 , Nicolas Lellouche  9
Affiliations

Characteristics of patients with atrial fibrillation treated with direct oral anticoagulants and new insights into inappropriate dosing: results from the French National Prospective Registry: PAFF

Maxime Guenoun et al. Europace. .

Abstract

Aims: Since the introduction of direct oral anticoagulant (DOAC) for atrial fibrillation (AF) therapy, inappropriate and/or underdosing of these drugs has been a major clinical challenge. We evaluated the characteristics of patients with AF treated with inappropriate and low-dose DOACs.

Methods and results: Patients with AF treated with inappropriate and low-dose DOACs from October 2021 to December 2021 were evaluated from the French National Prospective Registry (PAFF). We evaluated 1890 patients with AF receiving DOACs (apixaban 55%, dabigatran 7%, and rivaroxaban 38%). Inappropriate dosing was noted in 18% of the population. Patients with appropriate dosing had less comorbidities: younger age (75 ± 10 vs. 82 ± 8 years old, P < 0.0001), reduced chronic renal failure (26 vs. 61%, P < 0.0001), and lower CHA2DS2VASc and HASBLED scores (3 ± 2 vs. 4 ± 3, P < 0.0001; 2 ±1 vs. 2 ± 2, P < 0.0001), respectively. In multivariate analysis, older age (P < 0.0001) and a higher CHA2DS2VASc score (P = 0.0056) were independently associated with inappropriate DOAC dosing. Among 472 patients (27%) treated with low-dose rivaroxaban or apixaban, 46% were inappropriately underdosed. Patients inappropriately underdosed were younger (82.3 ± 8.4 vs. 85.9 ± 5.9 years, P < 0.0001) with less chronic renal disease (47 vs. 98%, P < 0.0001). However, these patients had higher rates of prior haemorrhagic events (18 vs. 10%, P = 0.01), clopidogrel use (11 vs. 3%, P = 0.0002), and apixaban prescription (74 vs. 50%, P < 0.0001).

Conclusion: Within this large registry, DOACs were associated with inappropriate dosing in 18% of cases. Independent predictors of inappropriate dosing were high CHA2DS2VASc scores and older age. Moreover, 46% of patients treated with low-dose DOACs were inappropriately underdosed and more frequently in patients treated with apixaban.

Keywords: Atrial fibrillation; Direct oral anticoagulant; Inappropriate dosing.

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Conflict of interest statement

Conflict of interest: N.L. received consulting fees from Bayer and BMS-Pfizer.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Repartition of DOAC dosage in the study population (n = 1840 patients). DOAC, direct oral anticoagulant.
Figure 2
Figure 2
Repartition use of appropriate or inappropriate (under or overdosage) rivaroxaban (A) and apixaban (B) dosage.
See this image and copyright information in PMC

References

    1. Krijthe BP, Kunst A, Benjamin EJ, Lip GHY, Franco OH, Hofman Aet al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013;34:2746–51. - PMC - PubMed
    1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist Cet al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373–498. - PubMed
    1. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe Let al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018;39:1330–93. - PubMed
    1. Connolly SJ, Ezekowitz MD, Yusuf S, EIkelboom J, Oldgren J, Parekh Aet al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139–51. - PubMed
    1. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke Wet al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883–91. - PubMed

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