Kidney function monitoring and nonvitamin K oral anticoagulant dosage in atrial fibrillation

Abstract

Noncompliance with kidney function monitoring recommendations is common in NVAF patients starting NOAC, especially in elderly patients with kidney dysfunction. Compliance with kidney function monitoring recommendations was associated with adequate NOAC dosage at 1-year follow-up. Further studies are warranted to evaluate the implication of kidney function monitoring on prognosis.

Impact of direct oral anticoagulant off‐label doses on clinical outcomes of atrial fibrillation patients: A systematic review

“…(C) Real‐world studies results concerning dose adjustments of apixaban. (D) Results from direct oral anticoagulants overall adjustments regarding dose appropriateness…”

“…Yao et al reported that underdosing was associated with a higher risk of stroke particularly in apixaban‐treated patients, where the difference was statistically significant (HR: 4.87; 95% CI: 1.30 to 18.26; P = .02). 11 In dabigatran‐ or rivaroxaban‐treated patients without a renal indication there was no statistically significant difference . Furthermore, studies suggested that off‐label underdosing of apixaban without following the dose‐reduction criteria is associated with a nearly 5‐fold increased risk of stroke .…”

“…Canadian study, 44 where a total of 47 patients were included, among (D) Results from direct oral anticoagulants overall adjustments regarding dose appropriateness 5,9,11,25,27,28,32,34,37,39,40,42,44,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] whom 25 (53%) were receiving apixaban inconsistent with the ARIS-TOTLE trial and the product monograph.…”

“…11 In dabigatran-or rivaroxaban-treated patients without a renal indication there was no statistically significant difference. 9 Furthermore, studies suggested that off-label underdosing of apixaban without following the dose-reduction criteria is associated with a nearly 5-fold increased risk of stroke. 5,54 An important result from Ioannou et al 82 is that using a reduced dose of apixaban in patients with normal renal function and younger than 75 years was associated with 50% lower plasma concentrations than when treated with standard dose.…”

“…5,6 However, there is concern about the extrapolation of randomized clinical trials to real-life patients 7 since the reality observed in the idealized clinical trial setting is different from the real clinical practice, where patient characteristics and outcomes differ amongst distinct trials. 8 In fact, although fixed doses of DOACs are defined in the guidelines, dose adjustments are currently recommended in the presence of specific clinical conditions, including renal function, [9][10][11][12][13] age and body weight, 14,15 increased bleeding risk (e.g. gastritis, oesophagitis, gastroesophageal reflux) 16 and concomitantly administration with other drugs that compromise DOACs systemic exposition and pharmacological effects (e.g.…”