Background: Direct oral anticoagulants (DOACs) account for an increasing proportion of prescriptions in patients with non-valvular atrial fibrillation (NVAF) in primary care. Inappropriate dosing of DOACs is a common problem, with under-dosing being a particular issue. However, conflicting results have been reported about the factors independently associated with inappropriate dosing.
Aim: To describe inappropriate prescriptions of DOACs among patients in the CACAO French nationwide general practice cohort, and to identify the factors independently associated with inappropriate DOAC doses.
Design And Setting: Cross-sectional baseline analysis of the CACAO French national multicentre prospective cohort of adult patients in primary care receiving an oral anticoagulant who were recruited between April and October 2014.
Method: A total of 1111 patients from the CACAO cohort who received a DOAC for NVAF were included in this study. Inappropriate prescriptions of DOACs were described (inappropriate dosage, contraindications, non-indications, interactions, and non-compliance with the precautions for use). Multivariate logistic models were used to investigate factors associated with inappropriate DOAC dosing (under-dosing and over-dosing).
Results: Overall, 438 patients (39.4%) received at least one inappropriate DOAC prescription. The most common inappropriate prescription was inappropriate dosage ( = 374, 33.7%), particularly under-dosing ( = 348, 31.3%). Multivariate analysis revealed that factors independently associated with under-dosing were older age, prescription of apixaban or dabigatran, and a CHA2DS2-VASc score ≥2 vs. a score = 1. Factors with over-dosing were kidney failure, a HAS-BLED score ≥3, and older age.
Conclusion: The appropriateness of DOAC prescribing for NVAF can be improved, especially in older patients, and in patients with kidney failure, a higher risk of ischaemic stroke, and/or a higher risk of bleeding. GPs have a key role in increasing the proportion of appropriate DOAC prescriptions via informational, educational, and/or management strategies.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846350 | PMC |
| http://dx.doi.org/10.3399/bjgp20X714005 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Charting the path to the implementation of universal health coverage policy in Nigeria through the lens of Delphi methodology.
BMC Health Serv Res
January 2025
Society for Family Health, Abuja, Nigeria.
Background: Expanding access to equitable health insurance is an important lever towards the overall strategy for achieving universal health coverage. In Nigeria, health insurance coverage is low with a renewed government action on increasing access to and coverage of high-quality healthcare services to citizens, particularly for the vulnerable and poor population. Therefore, our study co-creates the priorities for expanding health insurance in Nigeria, focusing on key policy reforms, public advocacy, and innovative financing strategies to ensure broader and more equitable coverage for the population.
View Article and Find Full Text PDFBackground: Dental caries is one of the most common non-communicable diseases in humans. Various interventions are available for the management, of which microinvasive techniques such as infiltration, sealants, glass ionomers, are novel and convenient. The purpose of this systematic review and meta-analysis was to compare microinvasive techniques with noninvasive or invasive treatment modalities in terms of effectiveness in halting interproximal caries lesion progression radiographically assessed.
View Article and Find Full Text PDFInvestigation of the causal relationship between patient portal utilization and patient's self-care self-efficacy and satisfaction in care among patients with cancer.
BMC Med Inform Decis Mak
January 2025
Department of Industrial and Systems Engineering, University of Florida, 482 Weil Hall, PO BOX 116595, Gainesville, FL, 32611-6595, USA.
Objective: The objective of this study was to examine the causal relationship between the usage of patient portals and patients' self-care self-efficacy and satisfaction in care outcomes in the context of cancer care.
Methods: The National Institute's HINTS 5 Cycle 1-4 (2017-2020) data were used to perform a secondary data analysis. Patients who reported being ever diagnosed with cancer were included in the study population.
Families' opinions about their involvement in care during hospitalization: a mixed-methods study.
BMC Nurs
January 2025
Research Group Nursing Diagnostics, Family Care & Family Nursing, School of Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, Groningen, 9714 CA, The Netherlands.
Background: Healthcare professionals in the hospital setting frequently assume primary caregiving responsibilities, which often leads family members to perceive this as standard practice during hospitalization. This dynamic may create a gap between actual and desired levels of family involvement. The aim of this study is to explore the opinions of families about their involvement in care during the hospitalization of a relative.
View Article and Find Full Text PDFDevelopment of a pandemic-related core set of quality indicators for quality and patient safety in University Hospitals in Germany.
BMC Health Serv Res
January 2025
Institute for Health Services Research and Clinical Epidemiology, Faculty of Medicine, Philipps-University Marburg, Marburg, Germany.
Background: The COVID-19 pandemic entailed a global health crisis, significantly affecting medical service delivery in Germany as well as elsewhere. While intensive care capacities were overloaded by COVID cases, not only elective cases but also non-COVID cases requiring urgent treatment unexpectedly decreased, potentially leading to a deterioration in health outcomes. However, these developments were only uncovered retrospectively.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!