Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK
Objective To evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulants (NOACs) according to label in patients with non-valvular atrial fibrillation (NVAF) in the UK.Design Population-based cross-sectional study.Setting UK primary care.Populatio...
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BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e031341.full |
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| author | Mar Martín-Pérez Luis Alberto García Rodríguez Pareen Vora Luke Roberts Yanina Balabanova Gunnar Brobert Samuel Fatoba Kiliana Suzart-Woischnik Bernhard Schaefer Ana Ruigomez |
| author_facet | Mar Martín-Pérez Luis Alberto García Rodríguez Pareen Vora Luke Roberts Yanina Balabanova Gunnar Brobert Samuel Fatoba Kiliana Suzart-Woischnik Bernhard Schaefer Ana Ruigomez |
| author_sort | Mar Martín-Pérez |
| collection | DOAJ |
| description | Objective To evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulants (NOACs) according to label in patients with non-valvular atrial fibrillation (NVAF) in the UK.Design Population-based cross-sectional study.Setting UK primary care.Population 30 467 patients with NVAF and a first prescription for apixaban, dabigatran or rivaroxaban between January 2011 and December 2016.Main outcome measures Percentage of patients prescribed a NOAC dose according to the European Union (EU) labels (appropriately dosed), and not according to the EU labels (inappropriately dosed—including both underdosed and overdosed patients); percentage of patients prescribed an initial NOAC dose according to renal function status.Results A total of 15 252 (50.1%) patients started NOAC therapy on rivaroxaban, 10 834 (35.6%) on apixaban and 4381 (14.4%) on dabigatran. Among patients starting NOAC therapy on rivaroxaban, 17.3% were eligible to receive a reduced dose compared with 12.8% of patients starting on apixaban and 53.8% of patients starting on dabigatran. The majority of patients were prescribed an appropriate dose according to the EU labels: apixaban 74.9 %, dabigatran, 74.4%; rivaroxaban, 84.2%. Underdosing occurred in 21.6% (apixaban), 8.7% (dabigatran), 9.1% (rivaroxaban). Overdosing was more frequent for dabigatran (16.9%) than for rivaroxaban (6.6%) or apixaban (3.5%). There was a trend towards dose reduction with increasing renal impairment. Among patients with severe renal impairment, the majority received a reduced dose NOAC: apixaban, 91.1%, dabigatran, 80.0%, rivaroxaban, 83.0%.Conclusion Between 2011 and 2016, the majority of patients starting NOAC therapy in UK primary care were prescribed a daily dose in line with the approved EU drug label. Underdosing was more than twice as common among patients starting on apixaban than those starting on dabigatran or rivaroxaban. Research into the patient characteristics that may influence inappropriate underdosing of NOACs in UK primary care is warranted. |
| format | Article |
| id | doaj-art-14eeed74c60b4b9983ccf28adcc7532d |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-14eeed74c60b4b9983ccf28adcc7532d2025-08-20T01:54:11ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2019-031341Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UKMar Martín-Pérez0Luis Alberto García Rodríguez1Pareen Vora2Luke Roberts3Yanina Balabanova4Gunnar Brobert5Samuel Fatoba6Kiliana Suzart-Woischnik7Bernhard Schaefer8Ana Ruigomez91 Pharmacoepidemiology, Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, SpainSpanish Centre for Pharmacoepidemiologic Research, Madrid, SpainBayer AG, Berlin, Germany3 Study Medical Experts, Bayer PLC, Reading, UK2 Epidemiology, Bayer AG, Berlin, Germany3 Epidemiology, Bayer AB, Stockholm, Sweden5 Medical Affairs, Bayer PLC, Reading, UKBayer AG, Berlin, Germany2 Epidemiology, Bayer AG, Berlin, GermanySpanish Centre for Pharmacoepidemiologic Research, Madrid, SpainObjective To evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulants (NOACs) according to label in patients with non-valvular atrial fibrillation (NVAF) in the UK.Design Population-based cross-sectional study.Setting UK primary care.Population 30 467 patients with NVAF and a first prescription for apixaban, dabigatran or rivaroxaban between January 2011 and December 2016.Main outcome measures Percentage of patients prescribed a NOAC dose according to the European Union (EU) labels (appropriately dosed), and not according to the EU labels (inappropriately dosed—including both underdosed and overdosed patients); percentage of patients prescribed an initial NOAC dose according to renal function status.Results A total of 15 252 (50.1%) patients started NOAC therapy on rivaroxaban, 10 834 (35.6%) on apixaban and 4381 (14.4%) on dabigatran. Among patients starting NOAC therapy on rivaroxaban, 17.3% were eligible to receive a reduced dose compared with 12.8% of patients starting on apixaban and 53.8% of patients starting on dabigatran. The majority of patients were prescribed an appropriate dose according to the EU labels: apixaban 74.9 %, dabigatran, 74.4%; rivaroxaban, 84.2%. Underdosing occurred in 21.6% (apixaban), 8.7% (dabigatran), 9.1% (rivaroxaban). Overdosing was more frequent for dabigatran (16.9%) than for rivaroxaban (6.6%) or apixaban (3.5%). There was a trend towards dose reduction with increasing renal impairment. Among patients with severe renal impairment, the majority received a reduced dose NOAC: apixaban, 91.1%, dabigatran, 80.0%, rivaroxaban, 83.0%.Conclusion Between 2011 and 2016, the majority of patients starting NOAC therapy in UK primary care were prescribed a daily dose in line with the approved EU drug label. Underdosing was more than twice as common among patients starting on apixaban than those starting on dabigatran or rivaroxaban. Research into the patient characteristics that may influence inappropriate underdosing of NOACs in UK primary care is warranted.https://bmjopen.bmj.com/content/9/9/e031341.full |
| spellingShingle | Mar Martín-Pérez Luis Alberto García Rodríguez Pareen Vora Luke Roberts Yanina Balabanova Gunnar Brobert Samuel Fatoba Kiliana Suzart-Woischnik Bernhard Schaefer Ana Ruigomez Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK BMJ Open |
| title | Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK |
| title_full | Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK |
| title_fullStr | Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK |
| title_full_unstemmed | Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK |
| title_short | Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK |
| title_sort | appropriateness of initial dose of non vitamin k antagonist oral anticoagulants in patients with non valvular atrial fibrillation in the uk |
| url | https://bmjopen.bmj.com/content/9/9/e031341.full |
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