Dose reduction of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: A Danish nationwide cohort study

Xing, Lucas Yixi; Barcella, Carlo Alberto; Sindet-Pedersen, Caroline; Bonde, Anders; Gislason, Gunnar; Olesen, Jonas Bjerring

doi:10.1016/j.thromres.2019.04.007

Cited by 12 publications

(14 citation statements)

References 17 publications

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“…The predictors for dose reduction, other than dabigatran treatment, include advanced age, high CHA 2 DS 2 ‐VASc score, and high HAS‐BLED score …”

Section: Resultsmentioning

confidence: 99%

“…86 The predictors for dose reduction, other than dabigatran treatment, include advanced age, high CHA 2 DS 2 -VASc score, and high HAS-BLED score. 87 The role of the hospital pharmacist in medicines optimization goes obviously beyond OAC and studies undertaken in Brazil have shown that even in venous thromboembolism prevention, there is wide room for improvement as around 40% of hospitalized patients were found to receive inappropriate treatment. 88 Dose adaptation in the presence of renal impairment is also a key role for hospital pharmacists.…”

Section: Secondary Care For Episodes Of Ill Healthmentioning

confidence: 99%

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The patient pathway in cardiovascular care: A position paper from the International Pharmacists for Anticoagulation Care Taskforce (iPACT)

Costa

Rydant²,

Antoniou

2020

Evaluation Clinical Practice

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Background This position paper highlights the opportunistic integral role of the pharmacist across the patient pathway utilizing cardiovascular care as an example. The paper aims to highlight the potential roles that pharmacists worldwide can have (or already have) to provide efficient patient care in the context of interprofessional collaboration. Methods It results from a literature review and experts seeking advice to identify existing interventions and potential innovative interventions. We developed a conceptual framework highlighting seven critical phases in the patient pathway and for each of those listed some of the initiatives identified by our experts worldwide. Results Existing pharmacists' interventions in each of these phases have been identified globally. Various examples in the area of prevention and self‐management were found to exist for long; the contribution for early detection and subsequently to timely diagnosis were also quite clear; integration of care was perhaps one of the areas needing greater development, although interventions in secondary care were also quite common. Tertiary care and end of life interventions were found to often be left for other healthcare professionals. Conclusion On the basis of the findings, we can argue that much has been done but globally consider that pharmacists are still an untapped resource potentially useful for improved patient care.

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“…The predictors for dose reduction, other than dabigatran treatment, include advanced age, high CHA 2 DS 2 ‐VASc score, and high HAS‐BLED score …”

Section: Resultsmentioning

confidence: 99%

Section: Secondary Care For Episodes Of Ill Healthmentioning

confidence: 99%

The patient pathway in cardiovascular care: A position paper from the International Pharmacists for Anticoagulation Care Taskforce (iPACT)

Costa

Rydant²,

Antoniou

2020

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…In a previous Danish study, AF patients with more comorbidities, those receiving dabigatran treatment, and those aged older than 65 years were more likely to have a reduced DOAC dose. 42 An elevated risk of stroke, acute myocardial infarction, and major bleeding events were also associated with a reduced dosage of DOACs. 42 , 43 In the current study, we found that the dose of DOACs might affect osteoporotic fracture risk.…”

Section: Discussionmentioning

confidence: 99%

“… 42 An elevated risk of stroke, acute myocardial infarction, and major bleeding events were also associated with a reduced dosage of DOACs. 42 , 43 In the current study, we found that the dose of DOACs might affect osteoporotic fracture risk. Compared with standard-dose DOAC users, low-dose DOAC users had a higher risk of fracture, especially spine and osteoporotic fractures.…”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants and the risk of osteoporotic fractures in patients with non-valvular atrial fibrillation

Kuo

Lin

et al. 2021

Therapeutic Advances in Musculoskeletal

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Background: The incidence of osteoporotic fracture increases with age, particularly in elderly populations with atrial fibrillation (AF). However, direct oral anticoagulants (DOACs) have less effect on osteoporotic fracture than vitamin K antagonists, it is unclear whether the risk of osteoporotic fracture is affected by different types and doses of DOACs in AF patients. Methods: This nationwide population-based cohort study included AF patients prescribed DOACs between 2011 and 2016 taken from the Taiwan National Health Insurance database. Adjusted hazard ratios (aHRs) for the risk of osteoporotic, hip, and spine fractures between DOAC users were compared using the Fine and Gray subdistribution hazard model to adjust for possible confounders. Results: A total of 56,795 patients who were prescribed DOACs were included in the present study. Among them, 24,597 patients received dabigatran, 26,968 received rivaroxaban, and 5230 received apixaban. After 2 years’ follow up, there was no significant difference in the incidence of osteoporotic, spine, or hip fracture among those receiving dabigatran, rivaroxaban, or apixaban. Subgroup analysis showed that patients taking dabigatran had a higher incidence of osteoporotic and hip fracture than those taking rivaroxaban and apixaban in cases with concomitant peripheral artery disease (PAD) or a history of hip fracture ( p for interaction: 0.004 and 0.030, respectively). However, dabigatran users had a lower incidence of osteoporotic fracture and spine fracture in those receiving standard-dose DOACs compared with rivaroxaban and apixaban; whereas, they had a higher incidence of hip fractures when administered at low dose. Conclusion: AF patients with different DOACs did not have different risks of osteoporotic fracture overall. However, additional concomitant morbidities, such as PAD or a history of hip fracture, and standard/low doses might be associated with different risks for different DOACs. These findings should be taken into consideration in the clinic when the DOAC is being chosen. Plain language summary Different direct oral anticoagulants had different impact on osteoporotic fracture Anticoagulation therapy is an essential therapy in atrial fibrillation (AF) patients, but osteoporotic fracture is another important issue in these patients prescribed with anticoagulants. However, no study has been conducted to evaluate the impact of different DOACs on different types of osteoporotic fractures. In our findings, although different DOACs had no significantly different impact on osteoporotic fractures, dabigatran users had a slightly higher incidence of osteoporotic and hip fractures among different DOACs, particularly in those have simultaneously had peripheral artery disease, a history of hip fracture. In addition, when AF patients taking low-dose DOACs, dabigatran users also have higher incidence of hip fracture than those taking other DOACs.

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“…Undertreatment of AF, either in the form of no anticoagulation or in the use of inappropriately low-dose DOAC (low-dose in patients for whom standard-dose is approved) is a common practice in the general population, despite robust evidence of worse outcomes, i.e., lower efficacy with no safety gains [39,71,72]. A diagnosis of cancer appears to increase the odds of receiving inappropriately low-dose DOAC [73] (as well as those of not receiving anticoagulation [39]). In a small retrospective study of patients with cancer and AF, a worryingly high incidence of anticoagulation failure was seen in patients treated with low-dose DOAC [74].…”

Section: Conclusion and Future Needsmentioning

confidence: 99%

Oral anticoagulation in patients with active cancer and atrial fibrillation: current challenges

Sorigué

2020

Polish Archives of Internal Medicine

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.

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Dose reduction of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: A Danish nationwide cohort study

Cited by 12 publications

References 17 publications

The patient pathway in cardiovascular care: A position paper from the International Pharmacists for Anticoagulation Care Taskforce (iPACT)

The patient pathway in cardiovascular care: A position paper from the International Pharmacists for Anticoagulation Care Taskforce (iPACT)

Direct oral anticoagulants and the risk of osteoporotic fractures in patients with non-valvular atrial fibrillation

Oral anticoagulation in patients with active cancer and atrial fibrillation: current challenges

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