Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; and.
J Cardiovasc Pharmacol. 2021 Feb 1;77(2):182-188. doi: 10.1097/FJC.0000000000000913.
Direct oral anticoagulants (DOACs) have proven efficacy to prevent cardioembolic strokes. Data are scarce about the appropriateness of DOAC dosing in the Middle East. We investigated the prevalence of inappropriate DOAC dosing in the region. A cross-sectional study was conducted at our hospital between April 2015 and February 2019 of patients receiving 1 of the 3 available DOACs. Patients with incomplete data sets, those prescribed DOACs for indications other than atrial fibrillation, on DOACs for <30 days, and dialysis patients were excluded. A total of 608 met the inclusion criteria. The mean age was 65.2 ± 13.9 years, and most were men (58.6%). The mean CHA2DS2-VASc score was 3.8 ± 2.0. There were 346 (56.9%) on apixaban, 123 (20.2%) on dabigatran, and 139 (22.9%) on rivaroxaban. The logistic regression model showed that for the 3 agents together, age, eGFR, major bleeding history, and history of prior stroke were significantly associated with the decision to inappropriately underdose (P < 0.05). Fifteen patients had an ischemic stroke after apixaban initiation (5 underdosed and 3 overdosed). Among patients with at least one follow-up encounter, major bleeding occurred in 13 patients (11.7%) with inappropriate dosing compared with 29 patients (6.0%) with appropriate dosing (P = 0.04). Ischemic stroke occurred in 11 patients (9.9%) with inappropriate dosing compared with 15 patients (3.1%) with appropriate dosing (P < 0.01). We concluded that inappropriate DOAC underdosing is common in our region, particularly with apixaban and rivaroxaban. It is associated with increased risk of stroke and bleeding. More education targeting prescribers is needed to encourage adherence to standard dosing criteria.
直接口服抗凝剂（DOACs）已被证明能有效预防心源性脑卒。关于中东地区 DOAC 剂量的合理性的数据很少。我们调查了该地区 DOAC 剂量不合理的发生率。这是一项在 2015 年 4 月至 2019 年 2 月期间在我们医院进行的横断面研究，纳入了正在接受 3 种可用的 DOAC 之一的患者。排除了数据不完整、因非心房颤动而开 DOAC、服用 DOAC 不到 30 天和透析患者。共有 608 名符合纳入标准。平均年龄为 65.2 ± 13.9 岁，大多数为男性（58.6%）。平均 CHA2DS2-VASc 评分为 3.8 ± 2.0。346 名（56.9%）患者服用阿哌沙班，123 名（20.2%）患者服用达比加群，139 名（22.9%）患者服用利伐沙班。逻辑回归模型显示，对于这 3 种药物，年龄、肾小球滤过率、大出血史和既往卒中史与不合理低剂量（P < 0.05）的决定显著相关。阿哌沙班治疗后有 15 例发生缺血性卒中（5 例剂量不足，3 例剂量过多）。在至少有一次随访的患者中，13 例（11.7%）不合理剂量患者发生大出血，29 例（6.0%）合理剂量患者发生大出血（P = 0.04）。11 例（9.9%）不合理剂量患者发生缺血性卒中，15 例（3.1%）合理剂量患者发生缺血性卒中（P < 0.01）。我们的结论是，该地区 DOAC 剂量不合理的情况较为常见，尤其是阿哌沙班和利伐沙班。它与卒中风险和出血风险增加有关。需要更多针对医生的教育，以鼓励他们遵守标准剂量标准。
