Kido Kazuhiko, Shimizu Mikiko, Shiga Tsuyoshi, Hashiguchi Masayuki
J Am Pharm Assoc (2003). 2022 Mar-Apr;62(2):487-495.e2. doi: 10.1016/j.japh.2021.10.027. Epub 2021 Oct 27.
The appropriateness of direct oral anticoagulant (DOAC) dosing has been the issue in the real-world setting, and inappropriately lower DOAC dose may not be as effective or safe as the standard dose in patients with atrial fibrillation (AF). Multiple real-world studies compared the inappropriately lower DOAC dose versus the standard dose, but their main findings were contradictory.
A meta-analysis was performed to compare the efficacy and safety of the inappropriately lower DOAC dose with the standard DOAC dose in patients with AF. Database searches through May 30, 2021, were performed using Medline and Google Scholar. The primary efficacy outcome was stroke or systemic embolism, and the primary safety outcome was major bleeding. The secondary outcome was all-cause mortality.
A total of 16 studies were included in this meta-analysis. It revealed that the inappropriately lower DOAC dose was significantly associated with a higher event rate of stroke or systemic embolism compared with the DOAC standard dose (odds ratio 1.21 [95% CI 1.02-1.43], P = 0.03, I = 66%). There was no significant difference in the major bleeding event rate between these groups (1.03, [0.92-1.15], P = 0.62; I = 27%).
The inappropriately lower DOAC dose should be avoided to optimize DOAC effectiveness in patients with AF.
在现实环境中，直接口服抗凝剂（DOAC）的给药剂量是否合适一直是个问题，对于心房颤动（AF）患者，DOAC剂量过低可能不如标准剂量有效或安全。多项现实世界研究比较了DOAC低剂量与标准剂量，但主要结果相互矛盾。
进行一项荟萃分析，比较DOAC低剂量与标准剂量在AF患者中的疗效和安全性。使用Medline和谷歌学术对截至2021年5月30日的数据库进行检索。主要疗效结局是中风或全身性栓塞，主要安全性结局是大出血。次要结局是全因死亡率。
本荟萃分析共纳入16项研究。结果显示，与DOAC标准剂量相比，DOAC低剂量与中风或全身性栓塞的事件发生率显著升高相关（比值比1.21 [95%可信区间1.02 - 1.43]，P = 0.03，I = 66%）。两组大出血事件发生率无显著差异（1.03，[0.92 - 1.15]，P = 0.62；I = 27%）。
应避免使用过低的DOAC剂量，以优化AF患者的DOAC疗效。
