Polypharmacy and adverse events in atrial fibrillation: Main cause or reflection of multimorbidity?

NOACs in Atrial Fibrillation Patients with Polypharmacy

“…The higher rate of events in the VKA group could be related to both a lower time in therapeutic range (TTR) observed in patients with polypharmacy (as we can expect a lower adherence and then a lower TTR with a higher number of drugs taken) and greater likelihood of interactions with the other drugs prescribed, a finding related to the heterogeneity of AF cohorts. 22 However, it is not clear whether switching from a VKA to a NOAC would improve prognosis in patients in a TTR >70%. 23…”

“…The higher rate of events in the VKA group could be related to both a lower time in therapeutic range (TTR) observed in patients with polypharmacy (as we can expect a lower adherence and then a lower TTR with a higher number of drugs taken) and greater likelihood of interactions with the other drugs prescribed, a finding related to the heterogeneity of AF cohorts. 22 However, it is not clear whether switching from a VKA to a NOAC would improve prognosis in patients in a TTR >70%. 23 Beyond this, Grymonprez et al 15 clearly underline how polypharmacy represents both a proxy and a determinant of the overall clinical complexity, as well as an important risk factor for adverse outcomes, being able to influence effectiveness and safety of OAC.…”