Use of the low dose of direct action anticoagulants in patients with atrial fibrillation and flutter in an Emergency Service
Introduction: The efficacy of the new direct-acting anticoagulants (ACOD) in the prevention of thromboembolic events in patients with atrial fibrillation (AF) and Flutter (FL) has been demonstrated by many studies. In many of them the safety of the drug over efficacy is higher and all these drugs have a low dose presentation to guarantee this safety.
Goals: To study the percentage of use of low doses of ACOD in patients with non-valvular atrial fibrillation (NVAF) and atrial flutter (FL), prescribed at the beginning, in the Emergency Services of Aragón. (Substudy SArA V)
Material or patients and method: SArA V is an observational, descriptive and retrospective study of patients over 14 years of age treated in the Emergency Services of the Hospitals of the Health Network of Aragón, with primary or secondary diagnosis of FANV or FL. Study period: from July 1 to December 31, 2012, 2013, 2014, 2015 and 2016. Data were obtained by reviewing the patient's computerized medical history and treated by means of ACCESS and subsequent study with SPSSv15. (Chi-square test)
Results: Total number of patients studied: 11,484. Of these, anticoagulation was started from the Emergency Services in: 6,737 (70.1%) (those who already had anticoagulation are not included). Start of anticoagulation with ACOD: 1.711 (25.4%), of which 471 (28%) the low dose was used. Profile of patients who were prescribed the low dose: mean age 81.8 years; 60.5% women; average of CHA2DS2 VASc 4 points. Analyzing the ACOD: Dabigatran in 488 patients, 165 with the low dose of 110 mg (44%); Rivaroxaban 754 patients, 195 with low dose of 15 mg (26%); Apixaban 432 patients, 100 with the low dose of 2.5 mg (23%); Edoxaban 33 patients, 7 with a low dose of 30 mg (21%). Overall, 28% of the prescribed ACODs were in their corresponding low doses
Conclusions: Use of 28% of low doses of ACOD, similar to pivotal studies and below real-life studies (40%). Dabigatran 110 mg is the lowest dose of ACOD most used with 44% (only ACOD where the low dose was analyzed in a separate arm within its pivotal study and has indication of efficacy).
