Research
Print page Print page
Switch language
Rigshospitalet - a part of Copenhagen University Hospital
Published

Switching from Vitamin K Antagonist to Dabigatran in Atrial Fibrillation: Differences According to Dose

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. Temporal changes in the incidence of infective endocarditis in Denmark 1997-2017: A nationwide study

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Atrial fibrillation is a marker of increased mortality risk in non-ischemic heart failure - results from the DANISH Trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Work exposure and associated risk of hospitalisation with pneumonia and influenza: A nationwide study

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Vitamin K antagonists vs. direct oral anticoagulants after transcatheter aortic valve implantation in atrial fibrillation

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

AIMS: In atrial fibrillation (AF) patients 150 mg b.i.d. dabigatran is the standard dose, yet guidelines recommend 110 mg b.i.d. when bleeding risk is high. It is unknown to which extend these recommendations are followed in patients switching from vitamin K antagonist (VKA) to dabigatran. The aim of this study was to investigate if AF patients are switched from VKA to the appropriate dose of dabigatran.

METHODS AND RESULTS: Using nationwide registries (22 August 2011 to 31 December 2012), we identified VKA-experienced AF patients with available creatinine values who switched to dabigatran. European guidelines criteria 2012 on dabigatran dosing were examined: age ≥80 years, HAS-BLED ≥3, estimated glomerular filtration rate (eGFR)<50 mL/min/1.73 m2, or use of interacting drugs. We identified 1626 VKA-experienced AF patients who switched to dabigatran 110 mg (820 patients) or 150 mg (806 patients). Patients who switched to 110 mg compared with 150 mg were older [median age 82 years (Q1-Q3: 77-86) vs. 68 years (Q1-Q3: 64-74)], more often females (54% vs. 35%), had a higher comorbidity burden, higher proportion with CHA2DS2-VASc score ≥2 (98% vs. 80%), and more with a HAS-BLED score ≥3 (46% vs. 28%). Patients switched to 110 mg had a higher absolute risk of mortality compared with patients switched to 150 mg. Overall, 26% were inappropriately dosed and 14% were switched to 110 mg although the higher dose was indicated. Furthermore, 39% of patients switched to 150 mg fulfilled one or more criteria for 110 mg, this mostly driven by high HAS-BLED scores (28.2% of patients on 150 mg). Female sex, age ≥80 years, eGFR < 50 mL/min/1.73 m2, drugs interacting with dabigatran, and prior bleeding were associated with switch to 110 mg. Patients inappropriately dosed had similar risk of mortality as patients appropriately dosed.

CONCLUSION: Among VKA-experienced AF patients one in four were switched to a dabigatran dose contrary to guideline recommendations.

Original languageEnglish
JournalEuropean heart journal. Cardiovascular pharmacotherapy
Volume7
Issue number1
Pages (from-to)20-30
Number of pages11
ISSN2055-6837
DOIs
Publication statusPublished - 16 Jan 2021

Bibliographical note

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

ID: 58382693