title: A new gap in the novel anticoagulants' era: undertreatment.
abstract: After long years of using warfarin for atrial fibrillation, new oral anticoagulants (NOACs) became available for decreasing the risk of ischemic stroke. Our aim was to observe the physicians prescribing patterns of NOACs. This prospective observational study included patients using NOACs applying consecutively to our outpatient clinic. Physical examination was performed, and patient history, electrocardiogram, transthoracic echocardiography, and biochemical results were collected. Bleeding and ischemic stroke risk scores (HAS-BLED and CHA2DS2-VASc scores) were calculated. We evaluated patients' characteristics, risk factors, concomitant drug usage, and physicians' choices. The study consisted of 174 patients using NOACs (dabigatran 113 patients, rivaroxaban 61 patients), with a mean age of 70.7 ± 8.8 years. The mean HAS-BLED score was 1.74 ± 0.9 and the mean CHA2DS2-VASc score was 3.7 ± 1.2. Fifty-three (30.4%) patients were prescribed low-dose NOAC according to the optimal dose, and 12 (6.8%) patients were prescribed high-dose NOAC according to the optimal dose. We compared optimal dose and undertreatment groups to find out if there was any predicting factor for physicians to use low dose of NOACs, but there was no significant difference between the two groups for age, sex, concomitant chronic disease, and CHA2DS2-VASc and HAS-BLED scores. NOACs were prescribed to patients mostly with high CHA2DS2-VASc score and low HAS-BLED score. Low-dose NOAC usage according to the optimal dose was frequent. Frequent coagulation monitoring and drug incompliance are big deficiencies at atrial fibrillation in use of warfarin. NOACs overcome these difficulties; however, physicians' hesitation to use NOACs with the optimal dosage may be another limitation in real-world practice.
authors.affiliation: aDepartment of Cardiology, Okmeydani Training and Research Hospital bDepartment of Cardiology, Kagithane State Hospital cDepartment of Internal Medicine, Okmeydani Training and Research Hospital dDepartment of Cardiology, Mehmet Akif Ersoy Training and Research Hospital eDepartment of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey.
authors.forename: Erdal
authors.initials: E
authors.lastname: Belen
authors.forename: Ismail Polat
authors.initials: IP
authors.lastname: Canbolat
authors.forename: Akif
authors.initials: A
authors.lastname: Bayyigit
authors.forename: Aysen
authors.initials: A
authors.lastname: Helvaci
authors.forename: Hamdi
authors.initials: H
authors.lastname: Pusuroglu
authors.forename: Kadriye
authors.initials: K
authors.lastname: Kilickesmez
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D000991:Antithrombins / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000069604:Dabigatran / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D000069604:Dabigatran