Faculty of Pharmacy, Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia.
Medicine (Baltimore). 2023 Sep 8;102(36):e35058. doi: 10.1097/MD.0000000000035058.
Possible challenges in dosing non-vitamin K antagonist oral anticoagulants in nonvalvular atrial fibrillation (NVAF) and limited evidence in Saudi Arabia make it difficult to assess their appropriateness. This study aimed to assess the appropriateness of prescribing rivaroxaban and apixaban in hospitalized patients with newly diagnosed NVAF. This single-center, descriptive, retrospective study was conducted at a tertiary hospital in Saudi Arabia between December 2018 and December 2019. The included patients were aged 18 years and older with newly diagnosed NVAF who received either rivaroxaban or apixaban during hospitalization. The primary outcome was the dosing appropriateness of rivaroxaban and apixaban in NVAF based on recent food and drug administration prescribing guidelines. Descriptive statistics including frequencies and percentages as well as mean ± standard deviation was used to summarize the data. Pearson Chi-square was used to test for significant difference in proportions of appropriate and inappropriate dosing. Pearson Correlation was used to test for associations between underdosing and overdosing with other patients characteristics. A priori P value < .05 was considered significant throughout. A total of 203 patients were included in our analysis. Majority of the patients {125 (61.6%), P = .001} received rivaroxaban. Overall, the dosing appropriateness observed in 143 (70.5%) of the patients who received the rivaroxaban and apixaban was significantly higher than the dosing inappropriateness observed in 60 (29.5%) of the patients who received the same drugs, P < .001. Apixaban had the highest proportion of patients, 45 (57.7%) with dosing inappropriateness. Overall, underdosing was the most common dosing inappropriateness observed in 53 (26.1%) of the patients. There was a significant negative correlation between the drugs underdosing and creatinine clearance, r = -0.223, P = .001. The findings in our present study showed that majority of the patients received appropriate dosing of rivaroxaban and apixaban in hospitalized patients with NVAF. Healthcare providers should update themselves with the recent dosing recommendations for the non-vitamin K-antagonist oral anticoagulants in NVAF to further improve the dosing appropriateness in hospitalized patients with NVAF.
在非瓣膜性心房颤动 (NVAF) 中，非维生素 K 拮抗剂口服抗凝剂的剂量可能存在挑战，而且沙特阿拉伯的证据有限，这使得评估其适宜性变得困难。本研究旨在评估利伐沙班和阿哌沙班在新诊断为 NVAF 的住院患者中的应用是否适宜。这是一项在沙特阿拉伯一家三级医院进行的单中心、描述性、回顾性研究，时间为 2018 年 12 月至 2019 年 12 月。纳入的患者年龄在 18 岁及以上，新诊断为 NVAF，在住院期间接受利伐沙班或阿哌沙班治疗。主要结局是根据最近的食品和药物管理局处方指南评估 NVAF 中利伐沙班和阿哌沙班的剂量适宜性。使用频率和百分比以及平均值±标准差等描述性统计数据对数据进行总结。使用 Pearson Chi-square 检验评估适宜剂量和不适宜剂量的比例是否存在显著差异。使用 Pearson 相关性检验评估剂量不足和剂量过高与其他患者特征之间的关联。整个研究中，预设 P 值<.05 具有统计学意义。我们的分析共纳入 203 例患者。大多数患者（125 例，61.6%，P =.001）接受了利伐沙班治疗。总体而言，接受利伐沙班和阿哌沙班治疗的 143 例（70.5%）患者的剂量适宜性显著高于接受相同药物治疗的 60 例（29.5%）患者的剂量不适宜性，P<.001。阿哌沙班的患者中剂量不适宜比例最高，45 例（57.7%）。总体而言，53 例（26.1%）患者的剂量不足是最常见的剂量不适宜情况。药物剂量不足与肌酐清除率之间存在显著负相关，r = -0.223，P =.001。我们目前的研究结果表明，大多数 NVAF 住院患者接受了利伐沙班和阿哌沙班的适宜剂量治疗。医疗保健提供者应更新自己对 NVAF 中非维生素 K 拮抗剂口服抗凝剂的最新剂量建议，以进一步提高 NVAF 住院患者的剂量适宜性。
