Anticoagulation in atrial fibrillation: NOAC prescribing in primary health care
Background Few studies assess the use of non-vitamin K antagonist oral anticoagulants (NOACs) in daily practice for the prevention of thromboembolic complications associated to nonvalvular atrial fibrillation (AF). Objectives Describe NOACs’ use and analyze its prescribing pattern. Evaluate possible factors associated to adverse events (AEs) and the applicability of prescription support forms. Methods We included patients with AF treated with a NOAC during 2014 in three primary healthcare centers in Barcelona, Spain. Demographic and clinical data was collected, as well as embolic and bleeding risk and reported AEs. Results A total of 101 patients were included, with a median age of 75 years. The NOACs most frequently prescribed were dabigatran and rivaroxaban. An 87.2% of the patients were receiving the recommended dosage. A potential bleeding risk was present in 47% of the subjects. Ten AEs were reported, of which eight hemorrhages. Patients who presented an AE were >65 years and had a higher proportion of concomitant treatment and/or co-morbidities that could prompt to bleeding (p < 0.001). Conclusions Current treatment practice is according to regulatory agencies’ recommendations. Close monitoring is especially needed in patients >65 years and at higher risk of bleeding. Prescription support forms help good prescribing and identifying potential individuals at high risk of AEs.
KeywordsAdverse events Anticoagulants Atrial fibrillation Drug utilization Primary health care Spain
No funding was received for the study.
Conflicts of interest
The authors declare that they have no conflict of interest.
- 5.Pradaxa® SPC (Boehringer Ingelheim International gmbH), 2011. http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf (2016). Accessed 22 Jun 2016.
- 8.Informe de posicionamiento terapéutico UT_ACOD/V5/21112016. Criterios y recomendaciones generales para el uso de los anticoagulantes orales directos (ACOD) en la prevención del ictus y la embolia sistémica en pacientes con fibrilación auricular no valvular. AEMPS, 2016 Nov. Accessed 21 Dec 2016.Google Scholar
- 10.Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(2719–47):3.Google Scholar