Low doses in direct oral anticoagulants. Do we prescribe it correctly?
Introduction:
The effectiveness of the new direct oral anticoagulants (DOACs) in the preventions of thromboembolic events in patients with non valvular atrial fibrillation (FANV) and Flutter (FL) has been showed from a multitude of studies. In many of them prioritize safety over effectiveness and all of them have a formulation of low dosis in order to guarantee this safety.
Aims:
We want to find out if the prescription of low doses of DOACs is appropiate, according to technical data, in patients with FANV and FL, prescribed at first, in Emergency Departments of Aragón. (Substudy SArA V).
Material or patients and methods:
SArA V is an observational, descriptive and retrospective study of patients over 14 years attending in the Emergency Departments of the Hospitals in the health network of Aragón, with main or secondary diagnosis of FANV or FL. Study period: between 1st of July to 31st December of 2012, 2013, 2014, 2015 y 2016. Data were obtained looking over computerized clinical history and were processed by ACCESS and subsequent study with SPSSv15. (Chi cuadrado test).
Results:
Total number of patients studied: 11.484. Of these, oral anticoagulation was started from Emergency departments in 6.737 (70,1%) (patients who already had anticoagulation were not included). Anticoagulation with DOACs was started in 1.711 patients (25,4%), of which 471 (28%) was with low doses.
Inadequate prescription of low DOACs doses, according to the specifications of the respective technical sheet: Dabigatrán: of 165 prescriptions, 34 were wrong (20,6%); Rivaroxaban of 195, 125 (64,2%); Apixaban: of 100, 51 (51%); Edoxaban: of 7 treatments, 4 were incorrect. The total of inadequate prescription of low doses of DOACs were of 154 (45.9%).
Regarding the change of anticoagulant treatment: in 19 cases (4%) there were changes, in 16 to antivitamin K drugs and in 3 patients to another DOACs.
Conclusions:
Very high percentage of inadequate prescription of low dose of DOACs, with 45,9%. Dabigatran 110 mg, is the DOACs with less percentage of inadequate prescription of low dose (20,6%), regarding technical sheet, probably by including the age as a independent guideline of dosis reduction
