title: Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study.
abstract: This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance ≥50 mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50 mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of ≥3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients.
authors: Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas Department of Cardiology, Kahramanmaraş Necip Fazıl State Hospital, Kahramanmaraş Department of Cardiology,Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon Department of Cardiology,Fethiye State Hospital, Fethiye Department of Cardiology, Elazığ Education and Research Hospital, Elazığ Department of Cardiology, Burdur State Hospital, Burdur Department of Cardiology, İskilip Atıf Hoca State Hospital, Corum Department of Cardiology, Samsun Education and Research Hospital, Samsun Department of Cardiology, Aksaray State Hospital, Aksaray Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır Department of Cardiology, Gönen State Hospital, Gönen Kartal Kosuyolu Heart Education and Research Hospital, Kartal, Istanbul, Turkey.
authors: Özcan
authors: Ö
authors: Başaran
authors: Volkan
authors: V
authors: Dogan
authors: Osman
authors: O
authors: Beton
authors: Mehmet
authors: M
authors: Tekinalp
authors: Ahmet Cağri
authors: AC
authors: Aykan
authors: Ezgi
authors: E
authors: Kalaycioğlu
authors: Ismail
authors: I
authors: Bolat
authors: Onur
authors: O
authors: Taşar
authors: Özgen
authors: Ö
authors: Şafak
authors: Macit
authors: M
authors: Kalcik
authors: Mehmet
authors: M
authors: Yaman
authors: Sinan
authors: S
authors: İnci
authors: Bernas
authors: B
authors: Altintaş
authors: Sedat
authors: S
authors: Kalkan
authors: Cevat
authors: C
authors: Kirma
authors: Murat
authors: M
authors: Biteker
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*; D014421:Turkey; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K