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Guenoun M, Cohen S, Villaceque M, Sharareh A, Schwartz J, Hoffman O, Dib JC, Ouazana L, Assouline S, Parrens E, Garban T, Pradeau V, Guedj-Meynier D, Lequeux B, Cohen C, Durand P, Dievart F, Dhanjal TS, Sabouret P, Lellouche N. Characteristics of patients with atrial fibrillation treated with direct oral anticoagulants and new insights into inappropriate dosing: results from the French National Prospective Registry: PAFF. Europace 2023; 25:euad302. [PMID: 37801642 PMCID: PMC10590101 DOI: 10.1093/europace/euad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/14/2023] [Indexed: 10/08/2023] Open
Abstract
AIMS Since the introduction of direct oral anticoagulant (DOAC) for atrial fibrillation (AF) therapy, inappropriate and/or underdosing of these drugs has been a major clinical challenge. We evaluated the characteristics of patients with AF treated with inappropriate and low-dose DOACs. METHODS AND RESULTS Patients with AF treated with inappropriate and low-dose DOACs from October 2021 to December 2021 were evaluated from the French National Prospective Registry (PAFF). We evaluated 1890 patients with AF receiving DOACs (apixaban 55%, dabigatran 7%, and rivaroxaban 38%). Inappropriate dosing was noted in 18% of the population. Patients with appropriate dosing had less comorbidities: younger age (75 ± 10 vs. 82 ± 8 years old, P < 0.0001), reduced chronic renal failure (26 vs. 61%, P < 0.0001), and lower CHA2DS2VASc and HASBLED scores (3 ± 2 vs. 4 ± 3, P < 0.0001; 2 ±1 vs. 2 ± 2, P < 0.0001), respectively. In multivariate analysis, older age (P < 0.0001) and a higher CHA2DS2VASc score (P = 0.0056) were independently associated with inappropriate DOAC dosing. Among 472 patients (27%) treated with low-dose rivaroxaban or apixaban, 46% were inappropriately underdosed. Patients inappropriately underdosed were younger (82.3 ± 8.4 vs. 85.9 ± 5.9 years, P < 0.0001) with less chronic renal disease (47 vs. 98%, P < 0.0001). However, these patients had higher rates of prior haemorrhagic events (18 vs. 10%, P = 0.01), clopidogrel use (11 vs. 3%, P = 0.0002), and apixaban prescription (74 vs. 50%, P < 0.0001). CONCLUSION Within this large registry, DOACs were associated with inappropriate dosing in 18% of cases. Independent predictors of inappropriate dosing were high CHA2DS2VASc scores and older age. Moreover, 46% of patients treated with low-dose DOACs were inappropriately underdosed and more frequently in patients treated with apixaban.
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Affiliation(s)
- Maxime Guenoun
- Almaviva Santé, Marseille, France
- College National des Cardiologues Français, Paris, France
| | - Serge Cohen
- College National des Cardiologues Français, Paris, France
| | | | - Ali Sharareh
- College National des Cardiologues Français, Paris, France
| | | | | | | | - Leon Ouazana
- College National des Cardiologues Français, Paris, France
| | | | - Eric Parrens
- College National des Cardiologues Français, Paris, France
- Clinique Tivoli-Ducos, Bordeaux, France
| | - Thierry Garban
- College National des Cardiologues Français, Paris, France
| | | | | | - Benoit Lequeux
- College National des Cardiologues Français, Paris, France
| | | | - Philippe Durand
- College National des Cardiologues Français, Paris, France
- Institut Arnaud Tzanck, Saint Laurent du Var, France
| | | | - Tarvinder S Dhanjal
- Department of Cardiac Electrophysiology, University of Warwick, Gibbet Hill, Coventry, UK
| | - Pierre Sabouret
- College National des Cardiologues Français, Paris, France
- Department of Cardiology, AP-HP, University Hospital Pitie-Salpetriere, Paris, France
| | - Nicolas Lellouche
- Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, Creteil 94000, France
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