Guideline-discordant dosing of direct-acting oral anticoagulants in the veterans health administration. Rose, A. J., Lee, J. S., Berlowitz, D. R., Liu, W., Mitra, A., & Yu, H. BMC health services research, 21(1):1351, December, 2021. doi abstract bibtex BACKGROUND: Clear guidelines exist to guide the dosing of direct-acting oral anticoagulants (DOACs). It is not known how consistently these guidelines are followed in practice. METHODS: We studied patients from the Veterans Health Administration (VA) with non-valvular atrial fibrillation who received DOACs (dabigatran, rivaroxaban, apixaban) between 2010 and 2016. We used patient characteristics (age, creatinine, body mass) to identify which patients met guideline recommendations for low-dose therapy and which for full-dose therapy. We examined how often patient dosing was concordant with these recommendations. We examined variation in guideline-concordant dosing by site of care and over time. We examined patient-level predictors of guideline-concordant dosing using multivariable logistic models. RESULTS: A total of 73,672 patients who were prescribed DOACS were included. Of 5837 patients who were recommended to receive low-dose therapy, 1331 (23%) received full-dose therapy instead. Of 67,935 patients recommended to receive full-dose therapy, 4079 (6%) received low-dose therapy instead. Sites varied widely on guideline discordant dosing; on inappropriate low-dose therapy, sites varied from 0 to 15%, while on inappropriate high-dose therapy, from 0 to 41%. Guideline discordant therapy decreased by about 20% in a relative sense over time, but its absolute numbers grew as DOAC therapy became more common. The most important patient-level predictors of receiving guideline-discordant therapy were older age and creatinine function being near the cutoff value. CONCLUSIONS: A substantial portion of DOAC prescriptions in the VA system are dosed contrary to clinical guidelines. This phenomenon varies widely across sites of care and has persisted over time.
@article{rose_guideline-discordant_2021,
title = {Guideline-discordant dosing of direct-acting oral anticoagulants in the veterans health administration},
volume = {21},
issn = {1472-6963},
doi = {10.1186/s12913-021-07397-x},
abstract = {BACKGROUND: Clear guidelines exist to guide the dosing of direct-acting oral anticoagulants (DOACs). It is not known how consistently these guidelines are followed in practice.
METHODS: We studied patients from the Veterans Health Administration (VA) with non-valvular atrial fibrillation who received DOACs (dabigatran, rivaroxaban, apixaban) between 2010 and 2016. We used patient characteristics (age, creatinine, body mass) to identify which patients met guideline recommendations for low-dose therapy and which for full-dose therapy. We examined how often patient dosing was concordant with these recommendations. We examined variation in guideline-concordant dosing by site of care and over time. We examined patient-level predictors of guideline-concordant dosing using multivariable logistic models.
RESULTS: A total of 73,672 patients who were prescribed DOACS were included. Of 5837 patients who were recommended to receive low-dose therapy, 1331 (23\%) received full-dose therapy instead. Of 67,935 patients recommended to receive full-dose therapy, 4079 (6\%) received low-dose therapy instead. Sites varied widely on guideline discordant dosing; on inappropriate low-dose therapy, sites varied from 0 to 15\%, while on inappropriate high-dose therapy, from 0 to 41\%. Guideline discordant therapy decreased by about 20\% in a relative sense over time, but its absolute numbers grew as DOAC therapy became more common. The most important patient-level predictors of receiving guideline-discordant therapy were older age and creatinine function being near the cutoff value.
CONCLUSIONS: A substantial portion of DOAC prescriptions in the VA system are dosed contrary to clinical guidelines. This phenomenon varies widely across sites of care and has persisted over time.},
language = {eng},
number = {1},
journal = {BMC health services research},
author = {Rose, Adam J. and Lee, Jong Soo and Berlowitz, Dan R. and Liu, Weisong and Mitra, Avijit and Yu, Hong},
month = dec,
year = {2021},
pmid = {34922546},
pmcid = {PMC8684634},
keywords = {Aged, Anticoagulants, Atrial Fibrillation, Atrial fibrillation, Dabigatran, Factor Xa Inhibitors, Humans, Medication therapy management, Quality of health care, Rivaroxaban, Veterans Health},
pages = {1351},
}
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We used patient characteristics (age, creatinine, body mass) to identify which patients met guideline recommendations for low-dose therapy and which for full-dose therapy. We examined how often patient dosing was concordant with these recommendations. We examined variation in guideline-concordant dosing by site of care and over time. We examined patient-level predictors of guideline-concordant dosing using multivariable logistic models. RESULTS: A total of 73,672 patients who were prescribed DOACS were included. Of 5837 patients who were recommended to receive low-dose therapy, 1331 (23%) received full-dose therapy instead. Of 67,935 patients recommended to receive full-dose therapy, 4079 (6%) received low-dose therapy instead. Sites varied widely on guideline discordant dosing; on inappropriate low-dose therapy, sites varied from 0 to 15%, while on inappropriate high-dose therapy, from 0 to 41%. Guideline discordant therapy decreased by about 20% in a relative sense over time, but its absolute numbers grew as DOAC therapy became more common. The most important patient-level predictors of receiving guideline-discordant therapy were older age and creatinine function being near the cutoff value. CONCLUSIONS: A substantial portion of DOAC prescriptions in the VA system are dosed contrary to clinical guidelines. This phenomenon varies widely across sites of care and has persisted over time.","language":"eng","number":"1","journal":"BMC health services research","author":[{"propositions":[],"lastnames":["Rose"],"firstnames":["Adam","J."],"suffixes":[]},{"propositions":[],"lastnames":["Lee"],"firstnames":["Jong","Soo"],"suffixes":[]},{"propositions":[],"lastnames":["Berlowitz"],"firstnames":["Dan","R."],"suffixes":[]},{"propositions":[],"lastnames":["Liu"],"firstnames":["Weisong"],"suffixes":[]},{"propositions":[],"lastnames":["Mitra"],"firstnames":["Avijit"],"suffixes":[]},{"propositions":[],"lastnames":["Yu"],"firstnames":["Hong"],"suffixes":[]}],"month":"December","year":"2021","pmid":"34922546","pmcid":"PMC8684634","keywords":"Aged, Anticoagulants, Atrial Fibrillation, Atrial fibrillation, Dabigatran, Factor Xa Inhibitors, Humans, Medication therapy management, Quality of health care, Rivaroxaban, Veterans Health","pages":"1351","bibtex":"@article{rose_guideline-discordant_2021,\n\ttitle = {Guideline-discordant dosing of direct-acting oral anticoagulants in the veterans health administration},\n\tvolume = {21},\n\tissn = {1472-6963},\n\tdoi = {10.1186/s12913-021-07397-x},\n\tabstract = {BACKGROUND: Clear guidelines exist to guide the dosing of direct-acting oral anticoagulants (DOACs). It is not known how consistently these guidelines are followed in practice.\nMETHODS: We studied patients from the Veterans Health Administration (VA) with non-valvular atrial fibrillation who received DOACs (dabigatran, rivaroxaban, apixaban) between 2010 and 2016. We used patient characteristics (age, creatinine, body mass) to identify which patients met guideline recommendations for low-dose therapy and which for full-dose therapy. We examined how often patient dosing was concordant with these recommendations. We examined variation in guideline-concordant dosing by site of care and over time. We examined patient-level predictors of guideline-concordant dosing using multivariable logistic models.\nRESULTS: A total of 73,672 patients who were prescribed DOACS were included. Of 5837 patients who were recommended to receive low-dose therapy, 1331 (23\\%) received full-dose therapy instead. Of 67,935 patients recommended to receive full-dose therapy, 4079 (6\\%) received low-dose therapy instead. Sites varied widely on guideline discordant dosing; on inappropriate low-dose therapy, sites varied from 0 to 15\\%, while on inappropriate high-dose therapy, from 0 to 41\\%. Guideline discordant therapy decreased by about 20\\% in a relative sense over time, but its absolute numbers grew as DOAC therapy became more common. The most important patient-level predictors of receiving guideline-discordant therapy were older age and creatinine function being near the cutoff value.\nCONCLUSIONS: A substantial portion of DOAC prescriptions in the VA system are dosed contrary to clinical guidelines. This phenomenon varies widely across sites of care and has persisted over time.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {BMC health services research},\n\tauthor = {Rose, Adam J. and Lee, Jong Soo and Berlowitz, Dan R. and Liu, Weisong and Mitra, Avijit and Yu, Hong},\n\tmonth = dec,\n\tyear = {2021},\n\tpmid = {34922546},\n\tpmcid = {PMC8684634},\n\tkeywords = {Aged, Anticoagulants, Atrial Fibrillation, Atrial fibrillation, Dabigatran, Factor Xa Inhibitors, Humans, Medication therapy management, Quality of health care, Rivaroxaban, Veterans Health},\n\tpages = {1351},\n}\n\n","author_short":["Rose, A. J.","Lee, J. S.","Berlowitz, D. 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