Advertisement

International Journal of Clinical Pharmacy

, Volume 39, Issue 2, pp 478–482 | Cite as

Anticoagulation in atrial fibrillation: NOAC prescribing in primary health care

  • Carla BastidaEmail author
  • Núria Corominas
  • José Miguel Sotoca
  • Marina Rovira
Short Research Report

Abstract

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.

Keywords

Adverse events Anticoagulants Atrial fibrillation Drug utilization Primary health care Spain 

Notes

Funding

No funding was received for the study.

Conflicts of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Ball J, Carrington MJ, McMurray JJV, Stewart S. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol. 2013;167:1807–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Veiga FF, Malfeito JMR, Barros CS, Magariños LMM. Oral anticogulation for non-valvular atrial fibrilation in the elderly. Rev espanola Geriatr y Gerontol. 2014;50(3):134–42.CrossRefGoogle Scholar
  3. 3.
    Larock A-S, Mullier F, Sennesael A-L, Douxfils J, Devalet B, Chatelain C, et al. Appropriateness of prescribing dabigatran etexilate and rivaroxaban in patients with nonvalvular atrial fibrillation: a prospective study. Ann Pharmacother. 2014;48:1258–68.CrossRefPubMedGoogle Scholar
  4. 4.
    Basaran O, Filiz Basaran N, Cekic EG, Altun I, Dogan V, Mert GO, et al. Prescription PATTERNS of oral anticoagulants in nonvalvular atrial fibrillation (PROPER study). Clin Appl Thromb Hemost. 2015;. doi: 10.1177/1076029615614395 (Epub ahead of print).Google Scholar
  5. 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.
  6. 6.
    Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137:263–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.CrossRefPubMedGoogle Scholar
  8. 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
  9. 9.
    Troncoso A, Diogène E. Dabigatran and rivaroxaban prescription for atrial fibrillation in Catalonia, Spain: the need to manage the introduction of new drugs. Eur J Clin Pharmacol. 2014;70:249–50.CrossRefPubMedGoogle Scholar
  10. 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
  11. 11.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Rev Española Cardiol (English ed). 2017;70:50.CrossRefGoogle Scholar
  12. 12.
    Abraham NS, Singh S, Alexander GC, Heien H, Haas LR, Crown W, et al. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study. BMJ. 2015;350:h1857.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  • Carla Bastida
    • 1
    Email author
  • Núria Corominas
    • 1
  • José Miguel Sotoca
    • 1
  • Marina Rovira
    • 1
    • 2
  1. 1.Pharmacy DepartmentHospital ClínicBarcelonaSpain
  2. 2.Grup Transversal de Recerca en Atenció Primària, IDIBAPSBarcelonaSpain

Personalised recommendations