直接口服抗凝剂治疗的心房颤动患者的特征及不适当剂量的新认识：来自法国全国前瞻性注册研究：PAFF。
Characteristics of patients with atrial fibrillation treated with direct oral anticoagulants and new insights into inappropriate dosing: results from the French National Prospective Registry: PAFF.
机构信息
Almaviva Santé, Marseille, France.
College National des Cardiologues Français, Paris, France.
出版信息
Europace. 2023 Oct 5;25(10). doi: 10.1093/europace/euad302.
AIMS
Since the introduction of direct oral anticoagulant (DOAC) for atrial fibrillation (AF) therapy, inappropriate and/or underdosing of these drugs has been a major clinical challenge. We evaluated the characteristics of patients with AF treated with inappropriate and low-dose DOACs.
METHODS AND RESULTS
Patients with AF treated with inappropriate and low-dose DOACs from October 2021 to December 2021 were evaluated from the French National Prospective Registry (PAFF). We evaluated 1890 patients with AF receiving DOACs (apixaban 55%, dabigatran 7%, and rivaroxaban 38%). Inappropriate dosing was noted in 18% of the population. Patients with appropriate dosing had less comorbidities: younger age (75 ± 10 vs. 82 ± 8 years old, P < 0.0001), reduced chronic renal failure (26 vs. 61%, P < 0.0001), and lower CHA2DS2VASc and HASBLED scores (3 ± 2 vs. 4 ± 3, P < 0.0001; 2 ±1 vs. 2 ± 2, P < 0.0001), respectively. In multivariate analysis, older age (P < 0.0001) and a higher CHA2DS2VASc score (P = 0.0056) were independently associated with inappropriate DOAC dosing. Among 472 patients (27%) treated with low-dose rivaroxaban or apixaban, 46% were inappropriately underdosed. Patients inappropriately underdosed were younger (82.3 ± 8.4 vs. 85.9 ± 5.9 years, P < 0.0001) with less chronic renal disease (47 vs. 98%, P < 0.0001). However, these patients had higher rates of prior haemorrhagic events (18 vs. 10%, P = 0.01), clopidogrel use (11 vs. 3%, P = 0.0002), and apixaban prescription (74 vs. 50%, P < 0.0001).
CONCLUSION
Within this large registry, DOACs were associated with inappropriate dosing in 18% of cases. Independent predictors of inappropriate dosing were high CHA2DS2VASc scores and older age. Moreover, 46% of patients treated with low-dose DOACs were inappropriately underdosed and more frequently in patients treated with apixaban.
目的
自直接口服抗凝剂（DOAC）用于房颤（AF）治疗以来，这些药物的不适当和/或剂量不足一直是一个主要的临床挑战。我们评估了接受不适当和低剂量 DOAC 治疗的 AF 患者的特征。
方法和结果
我们从法国全国前瞻性登记处（PAFF）评估了 2021 年 10 月至 2021 年 12 月期间接受不适当和低剂量 DOAC 治疗的 AF 患者。我们评估了 1890 名接受 DOAC 治疗的 AF 患者（阿哌沙班 55%、达比加群 7%和利伐沙班 38%）。人群中存在 18%的不适当剂量。适当剂量的患者合并症较少：年龄较小（75±10 岁与 82±8 岁，P<0.0001），慢性肾功能衰竭减少（26%与 61%，P<0.0001），CHA2DS2VASc 和 HASBLED 评分较低（3±2 与 4±3，P<0.0001；2±1 与 2±2，P<0.0001）。多变量分析显示，年龄较大（P<0.0001）和较高的 CHA2DS2VASc 评分（P=0.0056）与不适当的 DOAC 剂量相关。在 472 名（27%）接受低剂量利伐沙班或阿哌沙班治疗的患者中，46%的患者剂量不足。剂量不足的患者年龄较小（82.3±8.4 岁与 85.9±5.9 岁，P<0.0001），慢性肾病较少（47%与 98%，P<0.0001）。然而，这些患者既往出血事件发生率较高（18%与 10%，P=0.01），氯吡格雷使用率较高（11%与 3%，P=0.0002），阿哌沙班使用率较高（74%与 50%，P<0.0001）。
结论
在这个大型登记处中，18%的患者存在 DOAC 不适当剂量。不适当剂量的独立预测因素是较高的 CHA2DS2VASc 评分和年龄较大。此外，46%接受低剂量 DOAC 治疗的患者剂量不足，且更多见于接受阿哌沙班治疗的患者。
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