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Label Adherence of Direct Oral Anticoagulants Dosing and Clinical Outcomes in Patients With Atrial Fibrillation

DC Field Value Language
dc.contributor.author장은선-
dc.contributor.author유희태-
dc.contributor.author엄재선-
dc.contributor.author박희남-
dc.contributor.author이문형-
dc.contributor.author김태훈-
dc.contributor.author김종윤-
dc.contributor.author정보영-
dc.date.accessioned2020-09-28T11:59:26Z-
dc.date.available2020-09-28T11:59:26Z-
dc.date.issued2020-06-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/179311-
dc.description.abstractBackground Dose adjustment of non-vitamin K antagonist oral anticoagulants (NOACs) is indicated in some patients with atrial fibrillation (AF), based on selected patient factors or concomitant medications. We assessed the frequency of label adherence of NOAC dosing among AF patients and the associations between off-label NOAC dosing and clinical outcomes. Methods and Results We evaluated 53 649 AF patients treated with an NOAC using Korean National Health Insurance Service database during the period from 2013 to 2016. NOAC doses were classified as either underdosed or overdosed, consistent with Korea Food and Drug Administration labeling. Cox proportional hazards regression was performed to investigate the effectiveness and safety outcomes including stroke or systemic embolism, major bleeding, and all-cause mortality. Overall, 16 757 NOAC-treated patients (31.2%) were underdosed, 4492 were overdosed (8.4%), and 32 400 (60.4%) were dosed appropriately according to drug labeling. Compared with patients with label adherence, those who were underdosed or overdosed were older (aged 71±8 and 75±7 years versus 70±9 years, respectively; P<0.001) and had higher CHA2DS2-VASc scores (4.6±1.7 and 5.3±1.7 versus 4.5±1.8, respectively; P<0.001). NOAC overdosing was associated with increased risk for stroke or systemic embolism (5.76 versus 4.03 events/100 patient-years, P<0.001), major bleeding (4.77 versus 2.94 events/100 patient-years, P<0.001), and all-cause mortality (5.43 versus 3.05 events/100 patient-years, P<0.001) compared with label-adherent use. Conclusions In real-world practice, a significant proportion (almost 2 in 5) of AF patients received NOAC doses inconsistent with drug labeling. NOAC overdosing is associated with worse clinical outcomes in Asian AF patients.-
dc.description.statementOfResponsibilityopen-
dc.languageEnglish-
dc.publisherWiley-Blackwell-
dc.relation.isPartOfJOURNAL OF THE AMERICAN HEART ASSOCIATION-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.titleLabel Adherence of Direct Oral Anticoagulants Dosing and Clinical Outcomes in Patients With Atrial Fibrillation-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentBioMedical Science Institute (의생명과학부)-
dc.contributor.googleauthorHee Tae Yu-
dc.contributor.googleauthorPil-Sung Yang-
dc.contributor.googleauthorEunsun Jang-
dc.contributor.googleauthorTae-Hoon Kim-
dc.contributor.googleauthorJae-Sun Uhm-
dc.contributor.googleauthorJong-Youn Kim-
dc.contributor.googleauthorHui-Nam Pak-
dc.contributor.googleauthorMoon-Hyoung Lee-
dc.contributor.googleauthorGregory Y H Lip-
dc.contributor.googleauthorBoyoung Joung-
dc.identifier.doi10.1161/JAHA.119.014177-
dc.contributor.localIdA05608-
dc.contributor.localIdA02535-
dc.contributor.localIdA02337-
dc.contributor.localIdA01776-
dc.contributor.localIdA02766-
dc.contributor.localIdA01085-
dc.contributor.localIdA00926-
dc.contributor.localIdA03609-
dc.relation.journalcodeJ01774-
dc.identifier.eissn2047-9980-
dc.identifier.pmid32495677-
dc.subject.keywordatrial fibrillation-
dc.subject.keywordlabel adherence-
dc.subject.keywordnon‐vitamin K antagonist oral anticoagulants-
dc.subject.keywordoverdosing-
dc.subject.keywordunderdosing.-
dc.contributor.alternativeNameJang, Eunsun-
dc.contributor.affiliatedAuthor장은선-
dc.contributor.affiliatedAuthor유희태-
dc.contributor.affiliatedAuthor엄재선-
dc.contributor.affiliatedAuthor박희남-
dc.contributor.affiliatedAuthor이문형-
dc.contributor.affiliatedAuthor김태훈-
dc.contributor.affiliatedAuthor김종윤-
dc.contributor.affiliatedAuthor정보영-
dc.citation.volume9-
dc.citation.number12-
dc.citation.startPagee014177-
dc.identifier.bibliographicCitationJOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol.9(12) : e014177, 2020-06-
Appears in Collections:
1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers

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