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Inappropriate Direct Oral Anticoagulant Dosing in Atrial Fibrillation: a Portuguese Single-Center Study
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 10 – DOENÇA CARDIOVASCULAR EM DOENTES ONCOLÓGICOS E ANTICOAGULAÇÃO
Speaker:
Inês Brito E Cruz
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Brito e Cruz; Daniela Maurício; Ana Margarida Coutinho; Rita Bertão Ventura; Mafalda Gruiné; Tomás Carlos; Luísa Gomes Rocha; Maria João Primo; Didier Martinez; Luís Leite; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:14.0pt">INTRODUCTION</span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">Direct Oral Anticoagulants (DOACs) are the first-line treatment in Atrial Fibrillation (AF). These therapies require dose adjustments based on factors such as age, renal function, body weight, and drug-drug interactions, increasing the risk of inappropriate dosing. Multiple studies showed that incorrect dosing regimens, whether under or overdosing, are associated with increased morbidity and mortality. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">This study aimed to evaluate the prevalence of inappropriate DOAC dosing and assess the association between the type of DOAC and dosing appropriateness in a cohort of AF patients.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:14.0pt">METHODS </span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">A single-center retrospective study reviewed 685 patients who underwent an electrocardiogram in the emergency department between March 24 and March 30, 2024. Among these, 141 patients were identified as having either known or newly diagnosed AF. Patients were excluded if they were on warfarin, died during hospitalization, experienced major bleeding, had incomplete data. Those with specific conditions such as an estimated glomerular filtration rate <15 or total dependency were also excluded, resulting in 109 eligible patients. Dosing appropriateness was assessed according to the European Society of Cardiology guidelines 2024 for AF. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:14.0pt">RESULTS</span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">The cohort included 109 patients with AF (mean age 80.8 ± 11.8 years, 64% female) receiving DOACs: apixaban (n=45, 41%), edoxaban (n=35, 32%), rivaroxaban (n=19, 17%) and dabigatran (n=10, 9%). Inappropriate dosing was observed in 30 patients (28%), of whom 19 (63%) were underdosed and 11 (37%) were overdosed. Apixaban accounted for the</span> <span style="font-size:10.0pt">highest number of inappropriate doses (n=12, 9 underdoses, 3 overdoses). Rivaroxaban had 10 inappropriate doses (6 underdoses, 4 overdoses), while edoxaban had 8 (1 underdose, 7 overdoses). Notably, no inappropriate doses were observed with dabigatran. A chi-square test revealed a significant association between the type of DOAC and dosing appropriateness (p=0.017). Furthermore, the type of DOAC was also statistically significant for both underdosing (p=0.001) and overdosing (p=0.001) within the inappropriate dosing group.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:14.0pt">CONCLUSION</span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">This single-center study highlights that inappropriate DOAC dosing is a prevalent issue in clinical practice, particularly as underdosing. These findings underscore the importance of careful dosing and monitoring of DOAC regimens to minimize errors and reduce the risk of adverse outcomes in AF patients.</span></span></span></p>
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