Sato Takao, Aizawa Yoshifusa, Fuse Koichi, Fujita Satoshi, Ikeda Yoshio, Kitazawa Hitoshi, Takahashi Minoru, Okabe Masaaki
Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
J Stroke Cerebrovasc Dis. 2018 Nov;27(11):3280-3288. doi: 10.1016/j.jstrokecerebrovasdis.2018.07.028. Epub 2018 Aug 16.
Inappropriate doses of direct oral anticoagulants (DOACs) are often prescribed. This study evaluated the prevalence, outcomes, and predictors of the prescription of inappropriately low doses of 4 types of DOACs in patients with atrial fibrillation (AF).
We retrospectively analyzed prospectively collected data from a single-center registry with 2272 patients prescribed DOACs for AF (apixaban: 1014; edoxaban: 267; rivaroxaban: 498; dabigatran: 493). Patients were monitored for 2years and classified into appropriate-dose (n = 1,753; including appropriate low doses), inappropriate-low-dose (n = 490) and inappropriate-high-dose groups (n = 29). Major bleeding (MB) and thromboembolic events (TEEs) were evaluated.
The mean age was 72 ± 10years. The CHADS and HAS-BLED scores were 1.95 ± 1.32 and 1.89 ± .96, respectively. Overall, the incidences of MB and TEE were 2.3 and 2.1 per 100-patinet year, respectively. The inappropriate-low-dose group had younger age, heavier body weight, and higher creatinine clearance value than the appropriate-dose group. Multiple logistic regression analyses demonstrated the following independent determinants of the prescription of an inappropriately low dose: apixaban: HAS-BLED score; edoxaban: age; rivaroxaban: age, creatinine clearance value, HAS-BLED score, CHADS score, and antiplatelet therapy; dabigatran: age. There were not significant differences in the incidence of major bleeding and stroke/systemic emboli among the inappropriate-low-dose group of 4 DOACs compared with the appropriate-dose group of 4 DOACs.
In a single-center registry, 23% of patients with AF treated with a DOAC received an inappropriate dose. Several clinical factors, such as age and the creatinine clearance value, can identify patients at risk of under-treatment with DOACs.
直接口服抗凝剂（DOACs）的剂量常常开具不当。本研究评估了心房颤动（AF）患者中4种DOACs低剂量处方的发生率、结局及预测因素。
我们回顾性分析了前瞻性收集的来自单中心登记处的数据，该登记处有2272例因AF开具DOACs的患者（阿哌沙班：1014例；依度沙班：267例；利伐沙班：498例；达比加群：493例）。对患者进行了2年的监测，并分为合适剂量组（n = 1753；包括合适的低剂量）、低剂量不当组（n = 490）和高剂量不当组（n = 29）。评估了大出血（MB）和血栓栓塞事件（TEE）。
平均年龄为72±10岁。CHADS和HAS - BLED评分分别为1.95±1.32和1.89±0.96。总体而言，MB和TEE的发生率分别为每100患者年2.3例和2.1例。低剂量不当组比合适剂量组年龄更小、体重更重、肌酐清除率值更高。多因素逻辑回归分析显示了低剂量处方不当的以下独立决定因素：阿哌沙班：HAS - BLED评分；依度沙班：年龄；利伐沙班：年龄、肌酐清除率值、HAS - BLED评分、CHADS评分和抗血小板治疗；达比加群：年龄。4种DOACs的低剂量不当组与4种DOACs的合适剂量组相比，大出血和卒中/全身性栓塞的发生率无显著差异。
在单中心登记处，接受DOAC治疗的AF患者中有23%接受了不当剂量。年龄和肌酐清除率值等几个临床因素可识别DOAC治疗不足风险的患者。
