Study on the effectiveness and safety of under-dosing NOACs in non-valvular atrial fibrillation patients
Objective To investigate the clinical results of under-dosing non-Vitamin K antagonist oral anticoagulants(NOACs)used by patients with non valvular atrial fibrillation(NVAF)in the real world,so as to provide more reference and basis for the use of NOACs in NVAF patients and promote their clinical rational use.Methods Patients with NVAF treated with NOACs in the Affiliated Hospital of Xuzhou Medical University from January 2020 to April 2022 were included.The incidence of ischemic stroke/systemic embolism(IS/SE),bleeding events and all-cause mortality within 12 months were compared between patients treated with under-dosing NOACs and who with the dose recommended in the instruction manual(on-label dosing).Results Among 419 NVAF patients,286 patients used under-dosing NOACs(68.3%),of whom 201(48.0%)were Rivaroxaban and 85(20.3%)were Dabigatran.The results of multivariate Logistic regression showed that compared to on-label dosing,under-dosing was associated with a higher risk of IS/SE(OR:7.42;95%CI:1.50～36.70),and there was no significant difference in the incidence of bleeding events and all-cause mortality(P＞0.05).Conclusion The use of under-dosing NOACs may increase the risk of thromboembolism in NVAF patients,but can't reduce the expected risk of bleeding.To ensure the effectiveness and safety of anticoagulation therapy,caution should be done in using off-label under-dosing NOACs.
Non valvular atrial fibrillationNon-vitamin K antagonist oral anticoagulantsAnticoagulationBleedingEmbolization
NETL
NSTL
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