title: PRescriptiOn PattERns of Oral Anticoagulants in Nonvalvular Atrial Fibrillation (PROPER study).
abstract: BACKGROUND
  Inappropriate use of oral anticoagulants (OACs) have not been well investigatedand, however, may be frequent in real-world practice in patients with nonvalvular atrial fibrillation (NVAF). This study was designed to evaluate the prescription patterns and appropriateness of OACs in patients with NVAF in real-world clinical settings.
  
  
  METHODS
  We performed a prospective, observational study (NCT02366338). A total of 148 patients with NVAF were screened for OAC prescription. Appropriateness of prescribing was evaluated using 9 criteria of the Medication Appropriateness Index (MAI): indication, choice, dosage, modalities and practicability of administration, drug-drug interactions, drug-disease interactions, duplication, and duration. For each criterion, the evaluator has to rate whether the medication is (A) appropriate, (B) inappropriate but with limited clinical importance, and (C) inappropriate.
  
  
  RESULTS
  Of 148 patients, 73 (50%) were on warfarin (group 1), 39 (26%) were on rivaroxaban (group 2), and 36 (24%) were on dabigatran therapy (group 3). The MAI showed that 83% of group 1, 28% of group 2, and 47% of group 3 patients had at least 1 inappropriate criterion. Moreover, according to the choice criterion, 37% of group 1, 8% of group 2 and 5% of group 3 were rated as inappropriate, and dosage was not appropriate in 77% of group 1, 23% of group 2, and 42% of group 3.
  
  
  CONCLUSIONS
  Inappropriate drug use is frequent among patients with NVAF not only for warfarin but also for NOACs. Although there is an apparent improvement in thromboprophylaxis of NVAF, much more effort is needed for appropriate use of OACs.
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Ozcan
authors.initials: O
authors.lastname: Basaran
authors.affiliation: 2 Faculty of Medicine, Department of Medical Pharmacology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Nesrin
authors.initials: N
authors.lastname: Filiz Basaran
authors.affiliation: 2 Faculty of Medicine, Department of Medical Pharmacology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Edip Guvenc
authors.initials: EG
authors.lastname: Cekic
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Altun
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Dogan
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Gurbet Ozge
authors.initials: GO
authors.lastname: Mert
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Kadir Ugur
authors.initials: KU
authors.lastname: Mert
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Akin
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Mustafa Ozcan
authors.initials: MO
authors.lastname: Soylu
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Kadriye
authors.initials: K
authors.lastname: Memic Sancar
authors.affiliation: 1 Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Muğla, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D000925:Anticoagulants
keywords: anticoagulant agents; medication appropriateness index; non-vitamin K antagonists; nonvalvular atrial fibrillation