Effect of non‐recommended doses versus recommended doses of direct oral anticoagulants in atrial fibrillation patients: A meta‐analysis
Background Several observational studies have shown that the inappropriate dosing use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) that does not conform to recommendations is becoming a widespread phenomenon. Therefore, we performed a meta‐analysis and systematic review to asses...
Gespeichert in:
| Veröffentlicht in: | Clinical cardiology (Mahwah, N.J.) N.J.), 2021-04, Vol.44 (4), p.472-480 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 480 |
|---|---|
| container_issue | 4 |
| container_start_page | 472 |
| container_title | Clinical cardiology (Mahwah, N.J.) |
| container_volume | 44 |
| creator | Liu, Xuyang Huang, Manxiang Ye, Caisheng Xiao, Xiujuan Yan, Chengguang |
| description | Background
Several observational studies have shown that the inappropriate dosing use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) that does not conform to recommendations is becoming a widespread phenomenon. Therefore, we performed a meta‐analysis and systematic review to assess the effect of non‐recommended doses versus recommended doses of DOACs on the effectiveness and safety outcomes among AF patients.
Methods
The PubMed and Ovid databases were systematically searched to identify the relevant studies until December 2020. The effect estimates were hazard ratios (HRs) and 95% confidence intervals (CIs), which were pooled using a fixed‐effects model (I2 ≤ 50%) or a random‐effects model (I2 > 50%).
Results
A total of 11 studies were included in this meta‐analysis. Compared with recommended dosing of DOACs, non‐recommended low dosing of DOACs was associated with increased risks of stroke or systemic embolism (SSE, HR = 1.29, 95% CI 1.12–1.49) and all‐cause death (HR = 1.37, 95% CI 1.15–1.62), but not the ischemic stroke, myocardial infarction, gastrointestinal bleeding, intracranial bleeding, and major bleeding. Compared with recommended dosing of DOACs, non‐recommended high dosing of DOACs was associated with increased risks of SSE (HR = 1.44, 95% CI 1.01–2.04), major bleeding (HR = 1.99, 95% CI 1.48–2.68), and all‐cause death(HR = 1.38, 95% CI 1.02–1.87).
Conclusion
Compared with recommended dosing of DOACs, non‐recommended low dosing of DOACs was associated with increased risks of SSE and all‐cause death. Further study should confirm the findings of non‐recommended high dosing versus recommended dosing of DOACs. |
| doi_str_mv | 10.1002/clc.23586 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8027572</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2498992862</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5096-cf113f2635aba158b9b3423818013361c28e08d394469380dffa5b9d2bd17e843</originalsourceid><addsrcrecordid>eNp1kTtvFDEUhS0EIkug4A8gSzRQTOLHjMemiBStQoK0Eg3UlseP4GjGXuyZoO3oafiN_BJusiHiISpbOt89PscXoeeUHFFC2LEd7RHjnRQP0IoqzhrZ8_4hWhEqSKOYVAfoSa1XgBLJ-GN0wLmQjMp2hb6dheDtjHPAKacfX78Xb_M0-eS8wy5XX_G1L3Wp-F8BZlwst9PFjNikOdpsLpcRbhXHhM1cIgghDiWOo5ljTngLhwf9DT7Fk58NPGmSGXc11qfoUTBj9c_uzkP08e3Zh_VFs3l__m59umlsR5RobKCUByZ4ZwZDOzmogbeMSyoJhWLUMumJdFy1rVBcEheC6Qbl2OBo72XLD9HJ3ne7DJN3FuJAfr0tcTJlp7OJ-k8lxU_6Ml9rSVjf9QwMXt0ZlPx58XXWU6zWQ8Xk81I1a5VU8O_iBn35F3qVlwKFgYI2ba86IYB6vadsybUWH-7DUKJvVqxhxfp2xcC--D39PflrpwAc74EvcfS7_zvp9Wa9t_wJmla0uQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2509479566</pqid></control><display><type>article</type><title>Effect of non‐recommended doses versus recommended doses of direct oral anticoagulants in atrial fibrillation patients: A meta‐analysis</title><source>DOAJ Directory of Open Access Journals</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley-Blackwell Open Access Titles</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Liu, Xuyang ; Huang, Manxiang ; Ye, Caisheng ; Xiao, Xiujuan ; Yan, Chengguang</creator><creatorcontrib>Liu, Xuyang ; Huang, Manxiang ; Ye, Caisheng ; Xiao, Xiujuan ; Yan, Chengguang</creatorcontrib><description>Background
Several observational studies have shown that the inappropriate dosing use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) that does not conform to recommendations is becoming a widespread phenomenon. Therefore, we performed a meta‐analysis and systematic review to assess the effect of non‐recommended doses versus recommended doses of DOACs on the effectiveness and safety outcomes among AF patients.
Methods
The PubMed and Ovid databases were systematically searched to identify the relevant studies until December 2020. The effect estimates were hazard ratios (HRs) and 95% confidence intervals (CIs), which were pooled using a fixed‐effects model (I2 ≤ 50%) or a random‐effects model (I2 > 50%).
Results
A total of 11 studies were included in this meta‐analysis. Compared with recommended dosing of DOACs, non‐recommended low dosing of DOACs was associated with increased risks of stroke or systemic embolism (SSE, HR = 1.29, 95% CI 1.12–1.49) and all‐cause death (HR = 1.37, 95% CI 1.15–1.62), but not the ischemic stroke, myocardial infarction, gastrointestinal bleeding, intracranial bleeding, and major bleeding. Compared with recommended dosing of DOACs, non‐recommended high dosing of DOACs was associated with increased risks of SSE (HR = 1.44, 95% CI 1.01–2.04), major bleeding (HR = 1.99, 95% CI 1.48–2.68), and all‐cause death(HR = 1.38, 95% CI 1.02–1.87).
Conclusion
Compared with recommended dosing of DOACs, non‐recommended low dosing of DOACs was associated with increased risks of SSE and all‐cause death. Further study should confirm the findings of non‐recommended high dosing versus recommended dosing of DOACs.</description><identifier>ISSN: 0160-9289</identifier><identifier>EISSN: 1932-8737</identifier><identifier>DOI: 10.1002/clc.23586</identifier><identifier>PMID: 33682184</identifier><language>eng</language><publisher>New York: Wiley Periodicals, Inc</publisher><subject>Anticoagulants ; atrial fibrillation ; Cardiac arrhythmia ; Creatinine ; Drug dosages ; Meta-analysis ; off label ; Review ; Reviews ; Software ; Source studies ; Stroke ; stroke prevention</subject><ispartof>Clinical cardiology (Mahwah, N.J.), 2021-04, Vol.44 (4), p.472-480</ispartof><rights>2021 The Authors. published by Wiley Periodicals LLC.</rights><rights>2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.</rights><rights>2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5096-cf113f2635aba158b9b3423818013361c28e08d394469380dffa5b9d2bd17e843</citedby><cites>FETCH-LOGICAL-c5096-cf113f2635aba158b9b3423818013361c28e08d394469380dffa5b9d2bd17e843</cites><orcidid>0000-0003-0010-9068</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027572/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027572/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,1416,11553,27915,27916,45565,45566,46043,46467,53782,53784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33682184$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Xuyang</creatorcontrib><creatorcontrib>Huang, Manxiang</creatorcontrib><creatorcontrib>Ye, Caisheng</creatorcontrib><creatorcontrib>Xiao, Xiujuan</creatorcontrib><creatorcontrib>Yan, Chengguang</creatorcontrib><title>Effect of non‐recommended doses versus recommended doses of direct oral anticoagulants in atrial fibrillation patients: A meta‐analysis</title><title>Clinical cardiology (Mahwah, N.J.)</title><addtitle>Clin Cardiol</addtitle><description>Background
Several observational studies have shown that the inappropriate dosing use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) that does not conform to recommendations is becoming a widespread phenomenon. Therefore, we performed a meta‐analysis and systematic review to assess the effect of non‐recommended doses versus recommended doses of DOACs on the effectiveness and safety outcomes among AF patients.
Methods
The PubMed and Ovid databases were systematically searched to identify the relevant studies until December 2020. The effect estimates were hazard ratios (HRs) and 95% confidence intervals (CIs), which were pooled using a fixed‐effects model (I2 ≤ 50%) or a random‐effects model (I2 > 50%).
Results
A total of 11 studies were included in this meta‐analysis. Compared with recommended dosing of DOACs, non‐recommended low dosing of DOACs was associated with increased risks of stroke or systemic embolism (SSE, HR = 1.29, 95% CI 1.12–1.49) and all‐cause death (HR = 1.37, 95% CI 1.15–1.62), but not the ischemic stroke, myocardial infarction, gastrointestinal bleeding, intracranial bleeding, and major bleeding. Compared with recommended dosing of DOACs, non‐recommended high dosing of DOACs was associated with increased risks of SSE (HR = 1.44, 95% CI 1.01–2.04), major bleeding (HR = 1.99, 95% CI 1.48–2.68), and all‐cause death(HR = 1.38, 95% CI 1.02–1.87).
Conclusion
Compared with recommended dosing of DOACs, non‐recommended low dosing of DOACs was associated with increased risks of SSE and all‐cause death. Further study should confirm the findings of non‐recommended high dosing versus recommended dosing of DOACs.</description><subject>Anticoagulants</subject><subject>atrial fibrillation</subject><subject>Cardiac arrhythmia</subject><subject>Creatinine</subject><subject>Drug dosages</subject><subject>Meta-analysis</subject><subject>off label</subject><subject>Review</subject><subject>Reviews</subject><subject>Software</subject><subject>Source studies</subject><subject>Stroke</subject><subject>stroke prevention</subject><issn>0160-9289</issn><issn>1932-8737</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kTtvFDEUhS0EIkug4A8gSzRQTOLHjMemiBStQoK0Eg3UlseP4GjGXuyZoO3oafiN_BJusiHiISpbOt89PscXoeeUHFFC2LEd7RHjnRQP0IoqzhrZ8_4hWhEqSKOYVAfoSa1XgBLJ-GN0wLmQjMp2hb6dheDtjHPAKacfX78Xb_M0-eS8wy5XX_G1L3Wp-F8BZlwst9PFjNikOdpsLpcRbhXHhM1cIgghDiWOo5ljTngLhwf9DT7Fk58NPGmSGXc11qfoUTBj9c_uzkP08e3Zh_VFs3l__m59umlsR5RobKCUByZ4ZwZDOzmogbeMSyoJhWLUMumJdFy1rVBcEheC6Qbl2OBo72XLD9HJ3ne7DJN3FuJAfr0tcTJlp7OJ-k8lxU_6Ml9rSVjf9QwMXt0ZlPx58XXWU6zWQ8Xk81I1a5VU8O_iBn35F3qVlwKFgYI2ba86IYB6vadsybUWH-7DUKJvVqxhxfp2xcC--D39PflrpwAc74EvcfS7_zvp9Wa9t_wJmla0uQ</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Liu, Xuyang</creator><creator>Huang, Manxiang</creator><creator>Ye, Caisheng</creator><creator>Xiao, Xiujuan</creator><creator>Yan, Chengguang</creator><general>Wiley Periodicals, Inc</general><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0010-9068</orcidid></search><sort><creationdate>202104</creationdate><title>Effect of non‐recommended doses versus recommended doses of direct oral anticoagulants in atrial fibrillation patients: A meta‐analysis</title><author>Liu, Xuyang ; Huang, Manxiang ; Ye, Caisheng ; Xiao, Xiujuan ; Yan, Chengguang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5096-cf113f2635aba158b9b3423818013361c28e08d394469380dffa5b9d2bd17e843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anticoagulants</topic><topic>atrial fibrillation</topic><topic>Cardiac arrhythmia</topic><topic>Creatinine</topic><topic>Drug dosages</topic><topic>Meta-analysis</topic><topic>off label</topic><topic>Review</topic><topic>Reviews</topic><topic>Software</topic><topic>Source studies</topic><topic>Stroke</topic><topic>stroke prevention</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Xuyang</creatorcontrib><creatorcontrib>Huang, Manxiang</creatorcontrib><creatorcontrib>Ye, Caisheng</creatorcontrib><creatorcontrib>Xiao, Xiujuan</creatorcontrib><creatorcontrib>Yan, Chengguang</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Online Library Free Content</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical cardiology (Mahwah, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Xuyang</au><au>Huang, Manxiang</au><au>Ye, Caisheng</au><au>Xiao, Xiujuan</au><au>Yan, Chengguang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of non‐recommended doses versus recommended doses of direct oral anticoagulants in atrial fibrillation patients: A meta‐analysis</atitle><jtitle>Clinical cardiology (Mahwah, N.J.)</jtitle><addtitle>Clin Cardiol</addtitle><date>2021-04</date><risdate>2021</risdate><volume>44</volume><issue>4</issue><spage>472</spage><epage>480</epage><pages>472-480</pages><issn>0160-9289</issn><eissn>1932-8737</eissn><abstract>Background
Several observational studies have shown that the inappropriate dosing use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) that does not conform to recommendations is becoming a widespread phenomenon. Therefore, we performed a meta‐analysis and systematic review to assess the effect of non‐recommended doses versus recommended doses of DOACs on the effectiveness and safety outcomes among AF patients.
Methods
The PubMed and Ovid databases were systematically searched to identify the relevant studies until December 2020. The effect estimates were hazard ratios (HRs) and 95% confidence intervals (CIs), which were pooled using a fixed‐effects model (I2 ≤ 50%) or a random‐effects model (I2 > 50%).
Results
A total of 11 studies were included in this meta‐analysis. Compared with recommended dosing of DOACs, non‐recommended low dosing of DOACs was associated with increased risks of stroke or systemic embolism (SSE, HR = 1.29, 95% CI 1.12–1.49) and all‐cause death (HR = 1.37, 95% CI 1.15–1.62), but not the ischemic stroke, myocardial infarction, gastrointestinal bleeding, intracranial bleeding, and major bleeding. Compared with recommended dosing of DOACs, non‐recommended high dosing of DOACs was associated with increased risks of SSE (HR = 1.44, 95% CI 1.01–2.04), major bleeding (HR = 1.99, 95% CI 1.48–2.68), and all‐cause death(HR = 1.38, 95% CI 1.02–1.87).
Conclusion
Compared with recommended dosing of DOACs, non‐recommended low dosing of DOACs was associated with increased risks of SSE and all‐cause death. Further study should confirm the findings of non‐recommended high dosing versus recommended dosing of DOACs.</abstract><cop>New York</cop><pub>Wiley Periodicals, Inc</pub><pmid>33682184</pmid><doi>10.1002/clc.23586</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0010-9068</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0160-9289 |
| ispartof | Clinical cardiology (Mahwah, N.J.), 2021-04, Vol.44 (4), p.472-480 |
| issn | 0160-9289 1932-8737 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8027572 |
| source | DOAJ Directory of Open Access Journals; Wiley Online Library Journals Frontfile Complete; Wiley-Blackwell Open Access Titles; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Anticoagulants atrial fibrillation Cardiac arrhythmia Creatinine Drug dosages Meta-analysis off label Review Reviews Software Source studies Stroke stroke prevention |
| title | Effect of non‐recommended doses versus recommended doses of direct oral anticoagulants in atrial fibrillation patients: A meta‐analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T22%3A49%3A19IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20of%20non%E2%80%90recommended%20doses%20versus%20recommended%20doses%20of%20direct%20oral%20anticoagulants%20in%20atrial%20fibrillation%20patients:%20A%20meta%E2%80%90analysis&rft.jtitle=Clinical%20cardiology%20(Mahwah,%20N.J.)&rft.au=Liu,%20Xuyang&rft.date=2021-04&rft.volume=44&rft.issue=4&rft.spage=472&rft.epage=480&rft.pages=472-480&rft.issn=0160-9289&rft.eissn=1932-8737&rft_id=info:doi/10.1002/clc.23586&rft_dat=%3Cproquest_pubme%3E2498992862%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2509479566&rft_id=info:pmid/33682184&rfr_iscdi=true |