Abstract
Abstract 14148: Patient Characteristics and Predictors of Off-Label versus Standard Dosing of Direct Oral Anticoagulants in Medicare Beneficiaries With Atrial Fibrillation
Circulation (New York, N.Y.), Vol.138(Suppl_1 Suppl 1), pp.A14148-A14148
11/06/2018
DOI: 10.1161/circ.138.suppl_1.14148
Abstract
IntroductionOff-label dosing (OD) of direct oral anticoagulants (DOACs) may lead to increased risk for adverse events. We examined a large, community-based sample of patients with atrial fibrillation (AF) with a goal to identify patient characteristics related to OD among AF patients who qualify for low (LD) versus standard dosing of dabigatran (D) or rivaroxaban (R), based on U.S. FDA-approved dosing guidelines.MethodsWe identified Medicare beneficiaries enrolled in Humana managed care organizations from 2010 to 2016 with newly diagnosed AF (51,535 patients with AF [D14,320 on SD 150 mg twice daily (bid), and 2,215 on LD 75 mg bid, R23,999 on SD 20 mg daily, and 11,001 on LD 10 mg daily. Multivariable logistic regression analysis was performed to identify predictors of off-label dosing.ResultsLD eligible patients on D or R who received SD (D1,072, R5,168) were younger (p<0.001), more likely to be white (p<0.001), on strong P-glycoprotein and CYP3A4 (PGP/C3A4) inhibitors, less likely to have previous myocardial infarction (MI), heart failure (HF), and moderate or severe chronic kidney disease (CKD) than those who appropriately received LD (D:432, R5,039). SD eligible patients on D or R who received LD (D1,783, R:5,962) were older, more likely to be females with prior stroke, MI, major bleeding event, heart failure and moderate or severe CKD than those who were appropriately received SD (D13,248, R18,831).ConclusionsIn this cohort of Medicare beneficiaries with new-onset AF treated with DOACs between 2010 and 2016, a significant portion of patients were under- or over-dosed.
Details
- Title: Subtitle
- Abstract 14148: Patient Characteristics and Predictors of Off-Label versus Standard Dosing of Direct Oral Anticoagulants in Medicare Beneficiaries With Atrial Fibrillation
- Creators
- Alexandros Briasoulis - University of IowaYubo GaoMary Vaughan Sarrazin
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.138(Suppl_1 Suppl 1), pp.A14148-A14148
- Publisher
- by the American College of Cardiology Foundation and the American Heart Association, Inc
- DOI
- 10.1161/circ.138.suppl_1.14148
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 11/06/2018
- Academic Unit
- General Internal Medicine; Internal Medicine; Health Management and Policy
- Record Identifier
- 9984363438002771
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