Appropriateness of Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: Insights From the Veterans Health Administration
Appropriateness of Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: Insights From the Veterans Health Administration
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DOI：
10.1177/0897190019828270
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发表时间：
2020-10-01
影响因子：
1.3
通讯作者：
Turakhia, Mintu P.
中科院分区：
文献类型：
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作者：
Leef, George C.;Perino, Alexander C.;Turakhia, Mintu P.
背景：直接口服抗凝剂(DOAC)有严格的剂量指南，但最近的研究表明，不适当的剂量是常见的，特别是在慢性肾脏疾病(CKD)，据报道其比例高达43%。自2011年以来，退伍军人健康管理局(VA)对DOAC实施了抗凝管理计划，通常由药剂师领导，此前已被证明可以改善药物依从性。目的：我们调查了DOAC在退伍军人健康管理局中过量和不足剂量的发生率。方法：使用来自Treat-AF队列研究(房颤治疗的回顾评估和评估)的数据，我们确定了2003至2015年间新诊断为心房颤动(AF)并接受DOAC治疗的VA患者。结果：在230 762名患者中，5060名患者在房颤确诊后90天内(年龄69[10岁；CHA(2)DS(2)-VASc 1.6[1.4])接受了达比卡特兰(77.3%)或利伐沙班(22.7%)治疗，其中1312人(25.9%)根据估计的肾小球滤过率患有CKD
Background:Direct oral anticoagulants (DOACs) have strict dosing guidelines, but recent studies indicate that inappropriate dosing is common, particularly in chronic kidney disease (CKD), for which it has been reported to be as high as 43%. Since 2011, the Veterans Health Administration (VA) has implemented anticoagulation management programs for DOACs, generally led by pharmacists, which has previously been shown to improve medication adherence.Objective:We investigated the prevalence of overdosing and underdosing of DOACs in the VA.Methods:Using data from the TREAT-AF cohort study (The Retrospective Evaluation and Assessment of Therapies in AF), we identified VA patients with newly diagnosed atrial fibrillation (AF) and receipt of a DOAC between 2003 and 2015. We classified dosing as correct, overdosed, or underdosed based on the Food and Drug Administration-approved dosing criteria.Results:Of 230 762 patients, 5060 received dabigatran (77.3%) or rivaroxaban (22.7%) within 90 days of AF diagnosis (age 69 [10[ years; CHA(2)DS(2)-VASc 1.6 [1.4]), of which 1312 (25.9%) had CKD based on estimated glomerular filtration rate