Poor DOAC prescriptive practice persists in older AF patients

Prescriptive practice for direct oral anticoagulants (DOACs) remains suboptimal among older patients with atrial fibrillation (AF) discharged from acute medical wards, suggests a recent study. This condition is characterized by frequently missed prescription and DOAC underdosage.

A total of 609 patients with AF (mean age 85 years) enrolled from 39 geriatric and nephrology wards in Italy were included in the analysis. The authors examined DOAC prescriptive appropriateness according to the summary of product characteristics (smPC), 2019 Beers and STOPP criteria, and drug‒drug interactions (DDIs).

Of the AF patients, 33 percent were prescribed with DOAC, 26 percent with vitamin K antagonist, and 41 percent did not receive any anticoagulant upon discharge. Among those receiving DOAC, 31 percent presented a violation of the smPC criteria (mainly underdosage in 17 percent), while 48 percent presented a Beers and STOPP inappropriate prescription and 18 percent a DDI.

The following factors were independently associated with DOAC underdosage or missed prescription: older age (adjusted odds ratio [aOR], 1.06, 95 percent confidence interval [CI], 1.00‒1.12 for underdosage), higher estimated glomerular filtration rate (aOR, 1.04, 95 percent CI, 1.02‒1.07 for underdosage), lower body mass index (aOR, 0.95, 95 percent CI, 0.91‒0.99 for missed prescription), and cancer (aOR, 1.93, 95 percent CI, 1.19‒3.13 for missed prescription).

“Contrary to current recommendations, physicians appear overly concerned by bleeding risk in real-life older and frailer subjects,” the authors said. “Strategies should be developed to promote appropriate DOAC prescription in the hospital setting.”