Alali Nasser, Mahmoud Mahmoud Hassan, Alharbi Mousa Ayesh, Ghazal Sami Nimer
Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi ArabiaSaudi Arabia.
J Saudi Heart Assoc. 2019 Jul;31(3):130-134. doi: 10.1016/j.jsha.2019.05.002. Epub 2019 May 16.
Establishment of thromboembolism prevention remains a challenge despite the widespread consensus that thromboprophylaxis safely reduces patient morbidity and mortality. Dabigatran is a nonvitamin K antagonist oral anticoagulant (NOAC) which reduces the risk of thromboembolism. Proper dosing is important to achieve the maximum prophylactic benefit with a maintained safety profile.
To evaluate the appropriateness of dabigatran dosing for stroke and systemic embolism prevention in patients with nonvalvular atrial fibrillation (NVAF).
This is a retrospective cohort study of adults with NVAF. The data were collected from the electronic filing system of the hospital. Patients receiving dabigatran therapy were divided into two treatment groups according to the dose of dabigatran received. The indications for dabigatran as an oral direct anticoagulant, including age, risk of bleeding, creatinine clearance (CrCl), were collected. Appropriateness of dose reduction included any of the following factors: HAS-BLED score >2 points, age ≥75 years, or CrCl of 30-50 mL/min. The two groups were evaluated according to dose appropriateness.
Dabigatran dose of 110 mg was found to be inappropriately low in a large number of patients (31.3%). Multivariate regression analysis showed significant association of age and dose appropriateness ( < 0.001).
This study revealed inappropriate prescription of reduced doses of dabigatran in a large number of patients. Age was identified as the main driving factor for underdosing. Physicians' and pharmacists' awareness regarding this type of high-risk medication should be improved to ensure appropriate and safe use of this commonly used drug.
尽管普遍认为血栓预防可安全降低患者的发病率和死亡率，但建立血栓栓塞预防措施仍然是一项挑战。达比加群是一种非维生素K拮抗剂口服抗凝剂（NOAC），可降低血栓栓塞风险。正确给药对于在维持安全性的同时实现最大预防效益非常重要。
评估达比加群在非瓣膜性心房颤动（NVAF）患者中预防中风和全身性栓塞的给药合理性。
这是一项针对NVAF成人患者的回顾性队列研究。数据从医院的电子归档系统收集。接受达比加群治疗的患者根据所接受的达比加群剂量分为两个治疗组。收集达比加群作为口服直接抗凝剂的指征，包括年龄、出血风险、肌酐清除率（CrCl）。剂量降低的合理性包括以下任何因素：HAS-BLED评分>2分、年龄≥75岁或CrCl为30-50 mL/min。根据剂量合理性对两组进行评估。
发现大量患者（31.3%）的达比加群剂量为110 mg过低。多变量回归分析显示年龄与剂量合理性之间存在显著关联（<0.001）。
本研究揭示了大量患者中达比加群剂量降低的处方不合理。年龄被确定为剂量不足的主要驱动因素。应提高医生和药剂师对这类高风险药物的认识，以确保这种常用药物的合理和安全使用。
