Bruno Falissard1, Fabien Picard2, Isabelle Mahe3, Olivier Hanon4, Emmanuel Touzé5, Nicolas Danchin6, François-Xavier Lamy7, Léa Ricci8, Philippe Gabriel Steg9. 1. Inserm U669, Maison des Adolescents, Hôpital Cochin, AP-HP, 75679 Paris France; Université Paris Descartes, 75006 Paris, France. 2. Université Paris Descartes, 75006 Paris, France; Department of Cardiology, Hôpital Cochin, AP-HP, 75014 Paris, France. 3. FA-7334 Internal Medicine, Hôpital Louis-Mourier, Université Paris 7, AP-HP, 92700 Colombes, France. 4. Université Paris Descartes, 75006 Paris, France; Geriatrics Department, Hôpital Broca, AP-HP, 75013 Paris, France. 5. Normandie Université, UNICAEN, Inserm U1237, CHU Caen, 14000 Caen, France. 6. Université Paris Descartes, 75006 Paris, France; Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France. 7. ICTA, 21121 Fontaine-lès-Dijon, France. 8. Bristol-Myers Squibb, 92506 Rueil-Malmaison, France. 9. Department of Cardiology, Hôpital Bichat, AP-HP, 75018 Paris, France; Inserm U1148, Université Paris Diderot, 75877 Paris, France. Electronic address: gabriel.steg@aphp.fr.
Abstract
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs), including apixaban, are recommended for prevention of stroke and systemic embolism in non-valvular atrial fibrillation (NVAF). AIMS: To describe the characteristics of patients starting anticoagulant treatment, identify the characteristics associated with apixaban prescription, and describe apixaban use in France. METHODS: This was a non-interventional multicentre French study. Patients with NVAF (aged≥18 years) with anticoagulant treatment started in the preceding 3 months were evaluated in four groups (NOAC [apixaban, dabigatran or rivaroxaban] or vitamin K antagonist [VKA]). RESULTS: Data from 2027 patients were eligible for analysis. Mean age was 73.0±11.2 years, 56.6% were men and 80.2% were anticoagulant naïve. Stage≥4 chronic kidney disease was present in 2.2% of patients prescribed apixaban, none of those prescribed dabigatran or rivaroxaban, and 16.8% of those prescribed VKAs. The median CHA2DS2-VASc score was 3 for all three NOACs and 4 for VKAs; the median HAS-BLED score was≥3 for 2.5-5.9% of patients prescribed NOACs and 12.0% of those prescribed VKAs. Apixaban was more likely to be prescribed than other NOACs in older patients with higher bleeding risk and decreased renal function, and VKAs in patients with lower bleeding risk and better renal function. Patients received a reduced dose (5mg/day; 30.4% patients) or a full dose (10mg/day; 69.6% patients) of apixaban. Only 79.3% of patients prescribed apixaban had doses consistent with the summary of product characteristics; underdosing was more frequent than overdosing. Off-label use of apixaban was observed, mainly in elderly patients, despite normal renal function and weight. CONCLUSIONS: Initiation of apixaban versus NOACs was more common among patients with increased age, higher bleeding risk and decreased renal function, whereas initiation of apixaban versus VKAs was more common among patients with lower bleeding risk and better renal function.
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs), including apixaban, are recommended for prevention of stroke and systemic embolism in non-valvular atrial fibrillation (NVAF). AIMS: To describe the characteristics of patients starting anticoagulant treatment, identify the characteristics associated with apixaban prescription, and describe apixaban use in France. METHODS: This was a non-interventional multicentre French study. Patients with NVAF (aged≥18 years) with anticoagulant treatment started in the preceding 3 months were evaluated in four groups (NOAC [apixaban, dabigatran or rivaroxaban] or vitamin K antagonist [VKA]). RESULTS: Data from 2027 patients were eligible for analysis. Mean age was 73.0±11.2 years, 56.6% were men and 80.2% were anticoagulant naïve. Stage≥4 chronic kidney disease was present in 2.2% of patients prescribed apixaban, none of those prescribed dabigatran or rivaroxaban, and 16.8% of those prescribed VKAs. The median CHA2DS2-VASc score was 3 for all three NOACs and 4 for VKAs; the median HAS-BLED score was≥3 for 2.5-5.9% of patients prescribed NOACs and 12.0% of those prescribed VKAs. Apixaban was more likely to be prescribed than other NOACs in older patients with higher bleeding risk and decreased renal function, and VKAs in patients with lower bleeding risk and better renal function. Patients received a reduced dose (5mg/day; 30.4% patients) or a full dose (10mg/day; 69.6% patients) of apixaban. Only 79.3% of patients prescribed apixaban had doses consistent with the summary of product characteristics; underdosing was more frequent than overdosing. Off-label use of apixaban was observed, mainly in elderly patients, despite normal renal function and weight. CONCLUSIONS: Initiation of apixaban versus NOACs was more common among patients with increased age, higher bleeding risk and decreased renal function, whereas initiation of apixaban versus VKAs was more common among patients with lower bleeding risk and better renal function.
Authors: Iwona Gorczyca; Olga Jelonek; Beata Uziębło-Życzkowska; Magdalena Chrapek; Małgorzata Maciorowska; Maciej Wójcik; Robert Błaszczyk; Agnieszka Kapłon-Cieślicka; Monika Gawałko; Monika Budnik; Tomasz Tokarek; Renata Rajtar-Salwa; Jacek Bil; Michał Wojewódzki; Anna Szpotowicz; Janusz Bednarski; Elwira Bakuła-Ostalska; Anna Tomaszuk-Kazberuk; Anna Szyszkowska; Marcin Wełnicki; Artur Mamcarz; Beata Wożakowska-Kapłon Journal: J Clin Med Date: 2020-11-05 Impact factor: 4.241
Authors: Monika Budnik; Monika Gawałko; Iwona Gorczyca; Beata Uziębło-Życzkowska; Paweł Krzesiński; Janusz Kochanowski; Piotr Scisło; Anna Michalska; Olga Jelonek; Katarzyna Starzyk; Agnieszka Jurek; Marek Kiliszek; Beata Wożakowska-Kapłon; Grzegorz Gielerak; Krzysztof J Filipiak; Grzegorz Opolski; Agnieszka Kapłon-Cieślicka Journal: Cardiol J Date: 2020-03-24 Impact factor: 2.737