Appropriateness of initial dose of NOACs in patients with NVAF in the UK

What is it about?

Descriptive data show that a high proportion of patients with AF initiating anticoagulant therapy with a NOAC are prescribed a reduced dose, particularly in Europe, with evidence to suggest that many of these patients do not satisfy the necessary dose reduction criteria as specified on the drug labels.

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Why is it important?

Between 2011 and 2016, the majority of patients starting NOAC therapy in UK primary care were prescribed a daily dose in line with the approved EU drug label. Underdosing was more than twice as common among patients starting on apixaban than those starting on dabigatran or rivaroxaban. Our study is the first to comprehensively evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulant to patients with non-valvular atrial fibrillation in the UK according to the approved European Union drug labels, and the largest of its kind worldwide. Our large sample size was derived from two population-based data sources representative of the UK general population, both of which contained data on bodyweight and renal function.

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