title: Anticoagulation in atrial fibrillation: NOAC prescribing in primary health care.
abstract: Background Few studies assess the use of non-vitamin K antagonist oral anticoagulants (NOACs) in daily practice for the prevention of thromboembolic complications associated to nonvalvular atrial fibrillation (AF). Objectives Describe NOACs' use and analyze its prescribing pattern. Evaluate possible factors associated to adverse events (AEs) and the applicability of prescription support forms. Methods We included patients with AF treated with a NOAC during 2014 in three primary healthcare centers in Barcelona, Spain. Demographic and clinical data was collected, as well as embolic and bleeding risk and reported AEs. Results A total of 101 patients were included, with a median age of 75 years. The NOACs most frequently prescribed were dabigatran and rivaroxaban. An 87.2% of the patients were receiving the recommended dosage. A potential bleeding risk was present in 47% of the subjects. Ten AEs were reported, of which eight hemorrhages. Patients who presented an AE were >65 years and had a higher proportion of concomitant treatment and/or co-morbidities that could prompt to bleeding (p < 0.001). Conclusions Current treatment practice is according to regulatory agencies' recommendations. Close monitoring is especially needed in patients >65 years and at higher risk of bleeding. Prescription support forms help good prescribing and identifying potential individuals at high risk of AEs.
authors.affiliation: Pharmacy Department, Hospital Clínic, Barcelona, Spain. cbastida@clinic.ub.es.
authors.forename: Carla
authors.initials: C
authors.lastname: Bastida
authors.affiliation: Pharmacy Department, Hospital Clínic, Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Corominas
authors.affiliation: Pharmacy Department, Hospital Clínic, Barcelona, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Sotoca
authors.affiliation: Pharmacy Department, Hospital Clínic, Barcelona, Spain.|Grup Transversal de Recerca en Atenció Primària, IDIBAPS, Barcelona, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Rovira
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013923:Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Adverse events; Anticoagulants; Atrial fibrillation; Drug utilization; Primary health care; Spain