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Published on: February 28, 2012
PRescriptiOn PattERns of Oral Anticoagulants in Nonvalvular Atrial Fibrillation (PROPER study)
Ozcan Basaran1, Nesrin Filiz Basaran2, Edip Guvenc Cekic2
11 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
Introduction:
Inappropriate use of oral anticoagulants (OACs) have not been well investigatedand, however, may be frequent in real-world practice in patients with nonvalvular atrial fibrillation (NVAF). This study was designed to evaluate the prescription patterns and appropriateness of OACs in patients with NVAF in real-world clinical settings.
Methods:
We performed a prospective, observational study (NCT02366338). A total of 148 patients with NVAF were screened for OAC prescription. Appropriateness of prescribing was evaluated using 9 criteria of the Medication Appropriateness Index (MAI): indication, choice, dosage, modalities and practicability of administration, drug-drug interactions, drug-disease interactions, duplication, and duration. For each criterion, the evaluator has to rate whether the medication is (A) appropriate, (B) inappropriate but with limited clinical importance, and (C) inappropriate.
Results:
Of 148 patients, 73 (50%) were on warfarin (group 1), 39 (26%) were on rivaroxaban (group 2), and 36 (24%) were on dabigatran therapy (group 3). The MAI showed that 83% of group 1, 28% of group 2, and 47% of group 3 patients had at least 1 inappropriate criterion. Moreover, according to the choice criterion, 37% of group 1, 8% of group 2 and 5% of group 3 were rated as inappropriate, and dosage was not appropriate in 77% of group 1, 23% of group 2, and 42% of group 3.
Conclusion:
Inappropriate drug use is frequent among patients with NVAF not only for warfarin but also for NOACs. Although there is an apparent improvement in thromboprophylaxis of NVAF, much more effort is needed for appropriate use of OACs.
Insights
Inappropriate use of oral anticoagulants (OACs) is common in nonvalvular atrial fibrillation (NVAF) patients, affecting warfarin and newer agents. Further efforts are needed to ensure appropriate OAC prescribing for effective thromboprophylaxis.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Pharmacy
Background:
- Inappropriate use of oral anticoagulants (OACs) in nonvalvular atrial fibrillation (NVAF) is a potential real-world problem.
- This study aimed to investigate OAC prescription patterns and appropriateness in NVAF patients.
Purpose of the Study:
- To evaluate the real-world prescription patterns of OACs in patients with NVAF.
- To assess the appropriateness of OAC prescribing using the Medication Appropriateness Index (MAI).
Main Methods:
- Prospective, observational study involving 148 NVAF patients.
- OAC appropriateness assessed using 9 MAI criteria (indication, choice, dosage, etc.).
- Medication appropriateness rated as appropriate, inappropriate with limited clinical importance, or inappropriate.
Main Results:
- Warfarin (73 patients), rivaroxaban (39), and dabigatran (36) were prescribed.
- Inappropriate OAC use was found in 83% of warfarin, 28% of rivaroxaban, and 47% of dabigatran users.
- Specific inappropriateness noted in drug choice (37% warfarin vs. 8% rivaroxaban vs. 5% dabigatran) and dosage (77% warfarin vs. 23% rivaroxaban vs. 42% dabigatran).
Conclusions:
- Inappropriate OAC use is prevalent in NVAF patients, including with newer agents (NOACs).
- While thromboprophylaxis for NVAF shows improvement, optimizing OAC use requires further attention.
- Enhanced strategies are necessary to ensure appropriate OAC prescribing in clinical practice.
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