A cross-sectional study of appropriateness evaluation of anticoagulation therapy for inpatients with nonvalvular atrial fibrillation

Xiao-Yuan Zheng; Guang-Wei Feng; Jing Guo; Fen Xie; Xia Li; Ming-Zhu Zhang; Xiu-Fen Zhang; Xiu-Feng Wu; Yong-Juan Ding

doi:10.3389/fphar.2023.1286559

A cross-sectional study of appropriateness evaluation of anticoagulation therapy for inpatients with nonvalvular atrial fibrillation

Front Pharmacol. 2023 Dec 5:14:1286559. doi: 10.3389/fphar.2023.1286559. eCollection 2023.

Authors

Xiao-Yuan Zheng^#¹, Guang-Wei Feng^#², Jing Guo³, Fen Xie¹, Xia Li¹, Ming-Zhu Zhang^{4

5}, Xiu-Fen Zhang⁶, Xiu-Feng Wu¹, Yong-Juan Ding¹

Affiliations

¹ Department of Pharmacy, Affiliated Hospital of Jiangnan University, Wuxi, China.
² Department of Pharmacy, Dahua Hospital, Xuhui District, Shanghai, China.
³ Department of Cardiology, Affiliated Hospital of Jiangnan University, Wuxi, China.
⁴ Department of Pharmacy, Shandong Provincial Third Hospital, Jinan, China.
⁵ Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China.
⁶ Oncology Institute, Affiliated Hospital of Jiangnan University, Wuxi, China.

^# Contributed equally.

Abstract

Background: Oral anticoagulants (OACs) are essential for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). However, the appropriateness of anticoagulation treatment in locally practice remains unclear. This study evaluated compliance with anticoagulation therapy concerning the guidelines and drug labels in patients with NVAF. Methods: Hospitalized patients diagnosed with NVAF between 1 November 2020, and 31 December 2021, were retrospectively enrolled. The appropriateness of anticoagulation regimens at discharge was evaluated based on a flowchart designed according to atrial fibrillation (AF) guidelines and medication labels. Furthermore, we explored factors potentially influencing the "no-use of OACs" using binary logistic regression and verified anticoagulation-related issues through a physician questionnaire. Results: A total of 536 patients were enrolled in this study, including 254 patients (47.4%) with inappropriate anticoagulation regimens. 112 patients (20.9%) were categorized as "underdosing-use of OACs," 134 (25%) who needed anticoagulation therapy were "no-use of OACs" and eight (1.5%) were "over-use of OACs." The results of a binary logistic regression analysis showed that paroxysmal AF (odds ratio [OR], 7.74; 95% confidence interval [CI], 4.57-13.10), increased blood creatinine levels (OR, 1.88; 95% CI, 1.11-3.16), hospitalized pacemaker implantation (OR, 6.76; 95% CI, 2.67-17.11), percutaneous coronary intervention (OR, 3.35; 95% CI, 1.44-7.80), and an increased HAS-BLED score (OR, 1.62; 95% CI, 1.11-2.35) were associated with "no-use of OACs" in patients with NVAF who had indications for anticoagulation therapy. Conclusion: For patients with NVAF with severe renal dysfunction and paroxysmal AF, anticoagulation therapy was inadequate. The underdosing-use of OACs in patients with NVAF was frequently observed. We recommend an anticoagulation management team to tailor anticoagulation regimens to suit each patient's needs.

Keywords: anticoagulation therapy; clinical pharmacist; no-use of OACs; non-vitamin K antagonist oral anticoagulants; nonvalvular atrial fibrillation.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The Medical and Health Project of Science and Technology Development Plan, Wuxi, China, supported this study. (No. N20202028), the Shandong Province Medical and Health Technology Development Program (No. 2019WS456), and the Special Fund for Clinical Pharmaceutical Research of the Shandong Association of Chinese Medicine (No. SDACM202207).