Utilization of Dabigatran for Atrial Fibrillation at 3 Tertiary Care Centres

Carter, Aleesa A; Leblanc, Kori; Woods, Amita; Lowe, Donna

doi:10.4212/cjhp.v68i5.1483

Cited by 3 publications

(5 citation statements)

References 20 publications

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“…Both drugs have a potential to increase the bleeding risk. A previous study found that approximately 7% of dabigatran users were concomitantly receiving low molecular weight heparin [22]. Thus, a medication monitoring system to detect such contraindicated combinations is warranted to reduce the risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65

et al. 2019

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Objective In this study, we aimed to assess the utilization pattern (potentially inappropriate dosing and concomitant use of contraindicated drugs) and adherence to direct oral anticoagulants (DOACs), including apixaban, dabigatran, and rivaroxaban, in patients with atrial fibrillation (AF) unsuitable for warfarin. Methods We used nationally representative data, namely Health Insurance Review and Assessment Service-Aged Patient Sample 2014, that included medical and pharmacy claims of approximately 1 million patients aged 65 or older. We included patients who had at least one diagnosis of AF and at least one prescription of DOAC between January 1 and December 31, 2014. In 2014, DOACs were reimbursed only to patients with AF unsuitable for warfarin. Appropriate dosing and contraindicated drugs were determined according to the Summary of Product Characteristics for each DOAC. Multivariate logistic regression was performed to examine the factors contributing to the concomitant use of contraindicated drugs. To assess adherence, we calculated the medication possession ratio (MPR). Results The percentage of inappropriate dosing was 11.8% among 1,234 patients with AF; it was the highest in rivaroxaban users (16.8%). Contraindicated drugs were prescribed to 236 patients (19.1%). Clinics, smaller healthcare institutions, and outpatient visits were significantly related to contraindicated drug use. The mean MPRs were 0.95, 0.93, and 0.91 for apixaban, dabigatran, and rivaroxaban, respectively ( P = 0.075). Conclusions Careful monitoring is warranted in patients with AF aged over 65 who were unsuitable for warfarin to reduce the incidence of inappropriate dosing and concomitant use of contraindicated drugs.

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Section: Discussionmentioning

confidence: 99%

The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65

et al. 2019

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“…Thirty-seven percent of patients had potential interactions, which is just below the lower limit of the range collated from other studies with DOACs in clinical settings (40-88%). [28][29][30][31][32][33][34] Twice as many patients had potential PD-DDIs with DOACs compared with PK-DDIs, driven predominantly by concomitant use of SSRIs/SNRIs [ Figure 1(a, b)].…”

Section: Discussionmentioning

confidence: 99%

“…Third, apixaban, rivaroxaban and dabigatran were studied here, whereas most of the comparator studies included only dabigatran. [28][29][30][31][32][33][34] The prevalence difference could be explained because PPIs were classified as interacting drugs in several of the previous dabigatran studies, in which up to 64% of patients were taking dabigatran and PPIs together. 32 The rationale for this classification is that the bioavailability of dabigatran is dependent on an acidic gastric environment, and pantoprazole decreased dabigatran absorption by 30% in a phase I healthy volunteer study and by an average of 12.5% in RE-LY.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, when PPIs were included as perpetrators, this increased the overall prevalence of patients with potential interactions to 42%, consistent with the range of previous work (40-88%). [28][29][30][31][32][33][34] However, the consensus now is that interactions between dabigatran and PPIs are not clinically important. 5 Therefore, PPIs were excluded from the list of clinically relevant perpetrators (Table 2) and the final prevalence calculations.…”

Section: Discussionmentioning

confidence: 99%

“…have at least one potential DDI with DOACs. [28][29][30][31][32][33][34] For example, one study showed that nearly 80% of hospitalized patients on dabigatran had potential PK-DDIs, 32 whereas another showed that concomitant use of dabigatran with P-gp inhibitors occurred in 45% of patients. 33 Likewise, in a study of rivaroxaban after major orthopaedic surgery, there was a high prevalence of potential PD-DDIs, particularly with NSAIDs (52% of patients), although concomitant use of CYP3A or P-gp inhibitors or inducers was very low (<5% of patients).…”

Section: Introductionmentioning

confidence: 99%

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Potential drug–drug interactions with direct oral anticoagulants in elderly hospitalized patients

Forbes

Polasek

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Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation

Liao,

Chen,

Chen

2023

Open Medicine

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Patients with chronic obstructive pulmonary disease (COPD) had higher risk of atrial fibrillation (AF). The treatment of AF includes medicines to control heart rate and reduce the risk of stroke, and procedures such as cardioversion to restore normal heart rhythm. To reduce the stroke, patients with AF may prescribe some type of antithrombotic medication (such as warfarin, one of the new non-vitamin K antagonist oral anticoagulants [NOACs] – dabigitran, apixaban, rivoraxaban, or edoxaban) or maybe aspirin. The aim of our study was to exam the prescription pattern in patients with COPD and AF. We selected COPD population in Taiwan older than 40 years and less than 90 years old with an COPD diagnosis at least two outpatient claims or at least one inpatient claim coded and also need at least one prescription of bronchodilators. We followed this COPD cohort until they have AF and their prescription pattern. We included 267,740 patients with COPD who meet the inclusion and exclusion criteria and 6,582 patients concomitant with COPD and AF. The mean age was 75 years, and about 77% of the patients were older than 70 years. Three-fourths of patients with COPD were male. The common comorbidities were hypertension (17.58%), diabetes (7.47%), ischemic heart disease (4.66%), and dyslipidemia (3.68%). we found that most patients received aspirin which accounting for 31%, followed by coumadin (8.22%) and clopidogrel. Prescribing NOAC within 30 days after AF diagnosis was low in patients with COPD and the percentage of NOAC usage was also lower than warfarin.

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Utilization of Dabigatran for Atrial Fibrillation at 3 Tertiary Care Centres

Cited by 3 publications

References 20 publications

The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65

The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65

Potential drug–drug interactions with direct oral anticoagulants in elderly hospitalized patients

Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation

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