Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study

Basaran, Ozcan; Dogan, Volkan; Beton, Osman; Tekinalp, Mehmet; Aykan, Ahmet; Kalaycioglu, Ezgi; Bolat, Ismail; Tasar, Onur; Safak, Ozgen; Kalcik, Macit; Yaman, Mehmet; Inci, Sinan; Altintas, Bernas; Kalkan, Sedat; Kirma, Cevat; Biteker, Murat; Karadeniz, Fatma; Tekkesin, Ahmet; Cakilli, Yasin; Turkkan, Ceyhan; Hamidi, Mehmet; Demir, Vahit; Gursoy, Mustafa; Ozturk, Mujgan; Aksan, Gokhan; Seyis, Sabri; Balli, Mehmet; Alici, Mehmet; Bozyel, Serdar; Altun, Ibrahim; Calik, Feyza; Karaca, Oguz; Helvaci, Fusun; Akay, Kadriye; Canga, Yigit; Celebi, Savas; Altuntas, Emine; Ayturk, Mehmet; Gunes, Haci; Bezgin, Tahir; Aksakal, Aytekin; Cakal, Beytullah; Colak, Ayse; Kaplan, Ozgur; Tatlisu, Adem; Gozubuyuk, Gokhan; Demirelli, Selami; Kaya, Adnan; Rencuzogullari, Ibrahim; Bayram, Zubeyde; Simsek, Zeki; Civan, Murat; Batgharel, Ulaankhu; Ata, Ali; Gol, Gokhan; Mert, GURBET; Mert, KADİR; Degirmencioglu, Aleks; Candan, Ozkan; Celebi, Ozlem; Dogan, Cem; Yavuz, Fethi; Ulucan, Seref; Arisoy, Arif; Sahin, Bingul; Ermis, Emrah; Gokaslan, Serkan; Pektas, Idris; Tanindi, Asli; Tekin, Kamuran; Sancar, Kadriye; Cekic, Edip; Basaran, Nesrin

doi:10.1097/md.0000000000004672

Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study

Atıf İçin Kopyala

Basaran O., Dogan V., Beton O., Tekinalp M., Aykan A. C., Kalaycioglu E., ...Daha Fazla

MEDICINE, cilt.95, sa.35, 2016 (SCI-Expanded)

Yayın Türü: Makale / Tam Makale
Cilt numarası: 95 Sayı: 35
Basım Tarihi: 2016
Doi Numarası: 10.1097/md.0000000000004672
Dergi Adı: MEDICINE
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
Anahtar Kelimeler: anticoagulation, atrial fibrillation, off-label use, over-treatment, stroke, undertreatment, NONVALVULAR ATRIAL-FIBRILLATION, BLEEDING RISK, WARFARIN, DABIGATRAN, PHARMACODYNAMICS, PHARMACOKINETICS, RIVAROXABAN, APIXABAN
Eskişehir Osmangazi Üniversitesi Adresli: Hayır

Özet

This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance 50mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of 3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients.