Factors associated with inappropriate reduced doses of non-vita-min K antagonist oral anticoagulants in patients with atrial fibrillation
https://doi.org/10.24884/1607-4181-2021-28-1-52-61
Abstract
The objective was to study the factors associated with inappropriate reduced doses of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (AF) in real outpatient practice.
Methods and materials. 10663 case histories of patients hospitalized to the therapeutic clinic of the university for 5 years (2014 — 2018) were studied, 1307/10663 (12,3 %) case histories of patients with AF were selected. Factors associated with inappropriate low doses of anticoagulant therapy (ACT) with NOACs at prehospital treatment were studied.
Results. NOACs received 57.7 % (384/665) of patients with AF at the outpatient stage: rivaroxaban — 180/384 (46.9 %) patients, dabigatran etexilate — 110/384 (28.6 %) patients, apixaban — 94/384 (24.5 %) patients. Inappropriate reduced doses of NOACs were revealed in 68/384 (17.7 %) patients: apixaban — 22/94 (23.4 %), dabigatran — 18/110 (16,4 %) and rivaroxaban — 28/180 (15.6 %) (p>0,05). Patients who received inappropriate reduced doses of NOACs as compared to those who received standard doses of NOACs had higher frequency of major bleedings in the past (7.4 and 1.0 %; p=0.014) and had higher risk of bleedings (HAS-BLED 1.7±1,1 and 1.2±1.0; p = 0.0002). Proportion of patients who had HAS-BLED≥3 in these groups were 19.1 % and 8.6 % (p=0.033). All patients who received inappropriate reduced doses of NOACs had modifiable risk factors of bleedings. 85.3 % of patients with AF who received inappropriate reduced doses of NOACs had high risk of stroke according to CHA2DS2-VASc scale.
Conclusion. In real outpatient practice, NOACs were recommended to 57.7 % of patients with AF. 17.7 % of patients received NOACs s in inappropriate reduced doses. Frequency of major bleedings in the past and bleeding risk in AF patients with inappropriate reduced doses was higher than in patients with standard doses.
Keywords
Supporting agencies: The authors would like to thank G.I. Borisov, I. Ma, E.Yu. Petrishcheva, D.S. Skuridin for helping to build a database of patients with atrial fibrillation.
About the Authors
V. A. Ionin
Pavlov University; Almazov National Medical Research Centre
Russian Federation
Competing Interests:
Russian Federation
Ionin Valeriy A. - Cand. of Sci. (Med.), Associate Professor of the Department of Faculty Therapy, Pavlov University; Senior Research Fellow of the Research Laboratory of Metabolic Syndrome of the Institute of Endocrinology, Almazov National Medical Research Center.
6-8, L'va Tolstogo str., Saint Petersburg, 197022.
Competing Interests:
Authors declare no conflict of interest.
O. I. Bliznuk
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Bliznyuk Olga I. - 6th-year Student of the Faculty of Medicine, Pavlov University.
6-8, L'va Tolstogo str., Saint Petersburg, 197022.
Competing Interests:
Authors declare no conflict of interest.
V. A. Pavlova
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Pavlova Viktoriya A. - Clinical Resident of the Department of Faculty Therapy with Courses of Endocrinology, Cardiology and Functional Diagnostics with Clinic, Pavlov University.
6-8, L'va Tolstogo str., Saint Petersburg, 197022.
Competing Interests:
Authors declare no conflict of interest.
E. I. Baranova
Pavlov University; Almazov National Medical Research Centre
Russian Federation
Competing Interests:
Russian Federation
Baranova Elena I. - Dr. of Sci. (Med.), Professor of the Department of Faculty Therapy, Pavlov University; Head of the Research Laboratory of Metabolic Syndrome of the Institute of Endocrinology, Almazov National Medical Research Center.
6-8, L'va Tolstogo str., Saint Petersburg, 197022.
Competing Interests:
Authors declare no conflict of interest.
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Review
For citations:
Ionin V.A., Bliznuk O.I., Pavlova V.A., Baranova E.I. Factors associated with inappropriate reduced doses of non-vita-min K antagonist oral anticoagulants in patients with atrial fibrillation. The Scientific Notes of the Pavlov University. 2021;28(1):52-61. (In Russ.) https://doi.org/10.24884/1607-4181-2021-28-1-52-61
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