Relationship Between Direct Oral Anticoagulant Doses and Clinical Outcomes in Elderly Patients With Non-Valvular Atrial Fibrillation ― ANAFIE Registry Sub-Analysis ―
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- Akao Masaharu
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
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- Inoue Hiroshi
- Saiseikai Toyama Hospital
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- Yamashita Takeshi
- The Cardiovascular Institute
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- Atarashi Hirotsugu
- AOI Hachioji Hospital
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- Ikeda Takanori
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
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- Koretsune Yukihiro
- National Hospital Organization Osaka National Hospital
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- Okumura Ken
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
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- Suzuki Shinya
- The Cardiovascular Institute
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- Tsutsui Hiroyuki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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- Toyoda Kazunori
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Hirayama Atsushi
- Osaka Police Hospital
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- Yasaka Masahiro
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center, National Hospital Organization Kyushu Medical Center
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- Yamaguchi Takenori
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Teramukai Satoshi
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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- Kimura Tetsuya
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd.
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- Morishima Yoshiyuki
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd.
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- Takita Atsushi
- Data Intelligence Department, Daiichi Sankyo Co., Ltd.
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- Shimizu Wataru
- Department of Cardiovascular Medicine, Nippon Medical School, Tama Nagayama Hospital
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説明
<p>Background: This sub-analysis of the ANAFIE Registry, a prospective, observational study of >30,000 Japanese non-valvular atrial fibrillation (NVAF) patients aged ≥75 years, assessed the prevalence of direct oral anticoagulant (DOAC) under-dose prevalence, identified the factors of under-dose prescriptions, and examined the relationship between DOAC dose and clinical outcomes.</p><p>Methods and Results: Patients, divided into 5 groups by DOAC dose (standard, over-, reduced, under-, and off-label), were analyzed for background factors, cumulative incidences, and clinical outcome risk. Endpoints were stroke/systemic embolic events (SEE), major bleeding, and all-cause death during the 2-year follow-up. Of 18,497 patients taking DOACs, 20.7%, 3.8%, 51.6%, 19.6%, and 4.3%, were prescribed standard, over-, reduced, under-, and off-label doses. Factors associated with under-dose use were female sex, age ≥85 years, reduced creatinine clearance, history of major bleeding, polypharmacy, antiplatelet agents, heart failure, dementia, and no history of catheter ablation or cerebrovascular disease. After confounder adjustment, under-dose vs. standard dose was not associated with the incidence of stroke/SEE or major bleeding but was associated with a higher mortality rate. Patients receiving an off-label dose showed similar tendencies to those receiving an under-dose; that is, they showed the highest mortality rates for stroke/SEE, major bleeding, and all-cause death.</p><p>Conclusions: Inappropriate low DOAC doses (under- or off-label dose) were not associated with stroke/SEE or major bleeding but were associated with all-cause death.</p>
収録刊行物
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- Circulation Journal
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Circulation Journal 87 (12), 1765-1774, 2023-11-24
一般社団法人 日本循環器学会
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詳細情報 詳細情報について
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- CRID
- 1390861184043633536
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- NII書誌ID
- AA11591968
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- ISSN
- 13474820
- 13469843
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- NDL書誌ID
- 033193537
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- PubMed
- 37482411
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- 本文言語コード
- en
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- データソース種別
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- JaLC
- NDL
- Crossref
- PubMed
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- 抄録ライセンスフラグ
- 使用不可
