Artículos

Use of Direct Acting Oral Anticoagulants in Elderly Patients with Atrial Fibrillation: A Multicenter, Cross-Sectional Study in Spain

Pablo Díez-Villanueva1, Juan Cosín-Sales2, Vanesa Roldán-Schilling3, Vivencio Barrios4, Diana Riba-Artés5 and Olga Gavín-Sebastián6

  1. Cardiology Service, Hospital Universitario La Princesa, 28006 Madrid, Spain
  2. Cardiology Service, Hospital Arnau de Vilanova, 46015 Valencia, Spain
  3. Hematology Service, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
  4. Cardiology Service, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
  5. Medical Affairs Department, Boehringer Ingelheim España, Sant Cugat del Vallés, 08173 Barcelona, Spain
  6. Hematology Service, Hospital Clínico Lozano Blesa, 50009 Zaragoza, Spain

* Correspondence: Esta dirección de correo electrónico está protegida contra spambots. Usted necesita tener Javascript activado para poder verla.

J. Clin. Med. 2023, 12(3), 1224; https://doi.org/10.3390/jcm12031224 Published: 3 February 2023 · jcm-12-01224.pdf

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) have substantially improved anticoagulation. However, data on NOAC use among elderly patients are scarce. We sought to describe NOAC use among elderly AF patients in Spain. We performed a non-interventional, multicenter, multispecialty, cross-sectional study in elderly (≥75 years) AF patients treated with NOACs for stroke prevention. Patients’ characteristics by NOAC treatment were compared using standardized differences (SDD). NOAC dosing was classified according to the Spanish summary of products characteristics (SmPC) into appropriate (recommended dose) and inappropriate (under and overdosed). Multivariate logistic regression analyses were used to explore factors associated with inappropriate dosing. 500 patients were included. Mean (SD) age was 81.5 (4.7) years, and 50% were women. Mean (SD) creatinine clearance was 57.4 mL/min (18.8), and 23.6% were frail. Dabigatran treatment totaled 38.4%, rivaroxaban 15.2%, apixaban 33.2%, and edoxaban 13.2%. Almost one-fourth of elderly patients treated with NOACs in Spain were inappropriately dosed (underdosing 14.4% and overdosing 9.6%). Underdosing was significantly associated with weight (OR = 1.03, 95%CI = 1.0–1.1), while higher a EHRA score decreased the risk of underdosing (OR = 0.47, 95%CI = 0.2–1.0). Overdosing was significantly associated with a history of ischemic stroke (OR = 2.95, 95%CI = 1.1–7.7). Addressing incorrect dosing among elderly AF patients is relevant to improve patient outcomes.

Keywords: atrial fibrillation; elderly; frailty; non-vitamin K antagonist oral anticoagulants; inappropriate dosage; prescription monitoring

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