Abstract
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. We investigated the prevalence of overdosing and underdosing of DOACs in the VA. 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. Of 230 762 patients, 5060 received dabigatran (77.3%) or rivaroxaban (22.7%) within 90 days of AF diagnosis (age 69 [10[ years; CHA2DS2-VASc 1.6 [1.4]), of which 1312 (25.9%) had CKD based on estimated glomerular filtration rate <60. Overall, 93.6% of patients, 83.2% with CKD, received appropriate DOAC dosing. Incorrect dosing increased with worsening renal function. Compa...Continue Reading
References
Mar 13, 1999·Annals of Internal Medicine·A S LeveyD Roth
Nov 11, 1999·Journal of Medical Systems·D C CowperP A Murphy
Jun 13, 2001·JAMA : the Journal of the American Medical Association·B F GageM J Radford
Apr 21, 2004·Medical Care Research and Review : MCRR·Mark W Smith, George J Joseph
Nov 10, 2004·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Ann M BorzeckiDan R Berlowitz
Oct 15, 2005·Medical Care·Hude QuanWilliam A Ghali
Nov 1, 2005·Joint Commission Journal on Quality and Patient Safety·Clarence YapDavid Baker
Dec 15, 2012·American Heart Journal·Mintu P TurakhiaPaul A Heidenreich
Feb 20, 2013·Journal of Thrombosis and Haemostasis : JTH·W AgenoUNKNOWN Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on T
Dec 10, 2013·Lancet·Christian T RuffElliott M Antman
Jun 4, 2014·American Heart Journal·Supriya ShoreP Michael Ho
Aug 16, 2014·Journal of the American College of Cardiology·Mintu P TurakhiaPaul A Heidenreich
Oct 28, 2014·Pharmacotherapy·Kelli D BarnesStuart J Beatty
Apr 15, 2015·JAMA : the Journal of the American Medical Association·Supriya ShoreMintu P Turakhia
Jul 1, 2015·Thrombosis Journal·Hein HeidbuchelRiitta Lassila
Oct 9, 2015·Canadian Pharmacists Journal : CPJ = Revue Des Pharmaciens Du Canada : RPC·Tammy J BungardJennifer Lowerison
Nov 18, 2016·Heart·Felix YangMintu P Turakhia
Dec 17, 2016·Journal of the American College of Cardiology·Benjamin A SteinbergUNKNOWN ORBIT-AF Investigators and Patients
Jun 10, 2017·Journal of the American College of Cardiology·Xiaoxi YaoPeter A Noseworthy
Jul 1, 2017·Journal of the American College of Cardiology·Alexander C PerinoMintu P Turakhia
Jul 26, 2017·Frontiers in Cardiovascular Medicine·Ramin EbrahimiZenaida Feliciano
Citations
Jan 30, 2020·Journal of Evaluation in Clinical Practice·Filipa Alves da CostaSotiris Antoniou
Aug 12, 2020·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·G ChuM E W Hemels
Aug 30, 2020·European Heart Journal·Gerhard HindricksUNKNOWN ESC Scientific Document Group
Sep 5, 2019·British Journal of Clinical Pharmacology·Yoel AngelOri Rogowski
Nov 3, 2021·Circulation. Cardiovascular Quality and Outcomes·Alexander C PerinoMintu P Turakhia