Rates of Potentially Inappropriate Dosing of Direct-Acting Oral Anticoagulants and Associations With Geriatric Conditions Among Older Patients With Atrial Fibrillation: The SAGE-AF Study.

Journal of the American Heart Association
Saket R SanghaiDavid D McManus

Abstract

Background Direct-acting oral anticoagulant (DOAC) dosing guidelines for atrial fibrillation recommend dose alteration based on age, renal function, body weight, and drug-drug interactions. There is paucity of data describing the frequency and factors associated with prescription of potentially inappropriate doses. Methods and Results In the ongoing SAGE-AF (Systematic Assessment of Geriatric Elements in Atrial Fibrillation) study, we performed geriatric assessments (frailty, cognitive impairment, sensory impairments, social isolation, and depression) for participants with atrial fibrillation (age ≥65 years, CHA2DS2VASc ≥2, no anticoagulant contraindications). We developed an algorithm to analyze DOAC dose appropriateness accounting for drug-drug interactions, age, renal function, and body weight. We also examined whether geriatric impairments were related to inappropriate dosing. Of 1064 patients prescribed anticoagulants, 460 received a DOAC. Participants were aged 74±7 years, 49% were women, and 82% were white. A quarter (23%; n=105) of participants received inappropriate DOAC dose, of whom 82 (78%) were underdosed and 23 (22%) were overdosed. Among participants receiving an inappropriate dose, 12 (11%) were identified using...Continue Reading

References

Jan 1, 1976·Nephron·D W Cockcroft, M H Gault
Sep 1, 1988·Age and Ageing·G J MacpheeC H McAlpine
Mar 17, 2001·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·L P FriedUNKNOWN Cardiovascular Health Study Collaborative Research Group
Apr 9, 2005·Journal of the American Geriatrics Society·Ziad S NasreddineHoward Chertkow
Apr 22, 2005·Journal of Thrombosis and Haemostasis : JTH·S SchulmanUNKNOWN Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on T
Sep 1, 2009·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN RE-LY Steering Committee and Investigators
Aug 13, 2011·The New England Journal of Medicine·Manesh R PatelUNKNOWN ROCKET AF Investigators
Aug 30, 2011·The New England Journal of Medicine·Christopher B GrangerUNKNOWN ARISTOTLE Committees and Investigators
Nov 21, 2013·The New England Journal of Medicine·Robert P GiuglianoUNKNOWN ENGAGE AF-TIMI 48 Investigators
Jul 30, 2014·American Heart Journal·Benjamin A SteinbergUNKNOWN ORBIT-AF Steering Committee Investigators
Jul 7, 2015·The American Journal of Medicine·Geoffrey D BarnesZachary D Goldberger
Oct 28, 2015·Journal of the American Geriatrics Society·Jane S SaczynskiEdward R Marcantonio
Feb 18, 2016·The American Journal of Cardiology·Alan D BellAshfaq Shuaib
Jun 10, 2017·Journal of the American College of Cardiology·Xiaoxi YaoPeter A Noseworthy
Dec 1, 2017·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Martín Ruiz OrtizUNKNOWN FANTASIIA study investigators
Feb 18, 2018·Journal of the American Heart Association·Benjamin A SteinbergUNKNOWN Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT‐AF) II Investigators
Feb 7, 2019·Circulation Journal : Official Journal of the Japanese Circulation Society·Nobuhiro MurataUNKNOWN SAKURA AF Registry Investigators
Oct 2, 2019·Journal of the American Geriatrics Society·Jane S SaczynskiDavid D McManus

❮ Previous
Next ❯

Citations

Jun 17, 2020·Journal of the American Heart Association·Ashley ChenBruce A Warden
Nov 6, 2020·Journal of the American Heart Association·Taylor DawsonGeoffrey D Barnes
Aug 28, 2020·European Heart Journal. Cardiovascular Pharmacotherapy·Mario BoGaetano Maria De Ferrari
Feb 2, 2021·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Clara TingChristian T Ruff
Jun 15, 2021·Frontiers in Pharmacology·Roberta RobertiRita Citraro
Aug 5, 2021·Canadian Pharmacists Journal : CPJ = Revue Des Pharmaciens Du Canada : RPC·Lauren Adam
Oct 10, 2021·British Journal of Clinical Pharmacology·Andreas CapiauKoen Boussery
Nov 3, 2021·European Geriatric Medicine·M Cristina PolidoriUNKNOWN Special Interest Group “Cardiovascular Diseases” of the EuGMS
Nov 16, 2021·The New England Journal of Medicine·Jeffrey I WeitzUNKNOWN AXIOMATIC-TKR Investigators

❮ Previous
Next ❯

Software Mentioned

SAGE
AF

Related Concepts

Related Feeds

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.