ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Characteristics of patients with atrial fibrillation treated with direct oral anticoagulants and new insights into inappropriate dosing: results from the French National Prospective Registry: PAFF.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- [Update of the ESC atrial fibrillation guidelines : From the DGK commission for clinical cardiovascular medicine].Herzschrittmachertherapie & Elektrophysiologie · 2025Guideline
- Clinical Profile and Therapeutic Challenges in Atrial Fibrillation Patients with Moderate-to-Severe Chronic Kidney Disease: Insights from the CRAFT Registry.Journal of clinical medicine · 2026Article
- The application of low-dose rivaroxaban in elderly patients with atrial fibrillation.Frontiers in pharmacology · 2026Article
- Factors associated with oral anticoagulant non-use at first ischemic stroke in atrial fibrillation: A nationwide study.European stroke journal · 2026Article
- Anticoagulation in Frail Older Adults with Non-Valvular Atrial Fibrillation: Clinical Challenges and Personalized Approach.Journal of clinical medicine · 2025Review
- Direct oral anticoagulants in very elderly and high-bleeding-risk patients with atrial fibrillation often excluded from oral anticoagulation therapy: a nationwide population-based cohort study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Does hospitalisation improve oral anticoagulant optimisation in patients with atrial fibrillation?European journal of clinical investigation · 2025Observational
- Ischemic stroke prevention in patients with atrial fibrillation and a recent ischemic stroke, TIA, or intracranial hemorrhage: A World Stroke Organization (WSO) scientific statement.International journal of stroke : official journal of the International Stroke Society · 2025Review
- Direct-Acting Oral Anticoagulants and Potential Inconsistencies with FDA-Approved Dosing for Non-Valvular Atrial Fibrillation: A Retrospective Real-World Analysis Across Nine US Healthcare Systems.Journal of general internal medicine · 2025Article
- Increasing Very Low-Dose Edoxaban Prescription: Effectiveness and Safety Data of Korean AF Patients.Korean circulation journal · 2025Article
- Factors influencing the inappropriate dosing of rivaroxaban and edoxaban in Chinese hospitalized patients with atrial fibrillation.Frontiers in cardiovascular medicine · 2025Article
- Prevalence, risk characteristics, and prediction of low-dose edoxaban treatment in hospitalized patients: a multicenter, observational cohort study.Frontiers in pharmacology · 2025Article
- Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Review
- Article
- Association between antithrombotic therapy after stroke in patients with atrial fibrillation and the risk of net clinical outcome: an observational cohort study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Observational
- Association between antithrombotic therapy after stroke in patients with atrial fibrillation and the risk of net clinical outcome: an observational cohort study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Observational
- Prevalence of Atrial Fibrillation and Long-Term Survival of Older Adults; Findings from the SNAC Study.Gerontology & geriatric medicineArticle
Corrections and comments
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Authors and funding
20 authors at 6 institutions in 2 countries.
Funding
Abstract
aimsSince the introduction of direct oral anticoagulant (DOAC) for atrial fibrillation (AF) therapy, inappropriate and/or underdosing of these drugs has been a major clinical challenge. We evaluated the characteristics of patients with AF treated with inappropriate and low-dose DOACs. METHODS AND
resultsPatients with AF treated with inappropriate and low-dose DOACs from October 2021 to December 2021 were evaluated from the French National Prospective Registry (PAFF). We evaluated 1890 patients with AF receiving DOACs (apixaban 55%, dabigatran 7%, and rivaroxaban 38%). Inappropriate dosing was noted in 18% of the population. Patients with appropriate dosing had less comorbidities: younger age (75 ± 10 vs. 82 ± 8 years old, P < 0.0001), reduced chronic renal failure (26 vs. 61%, P < 0.0001), and lower CHA2DS2VASc and HASBLED scores (3 ± 2 vs. 4 ± 3, P < 0.0001; 2 ±1 vs. 2 ± 2, P < 0.0001), respectively. In multivariate analysis, older age (P < 0.0001) and a higher CHA2DS2VASc score (P = 0.0056) were independently associated with inappropriate DOAC dosing. Among 472 patients (27%) treated with low-dose rivaroxaban or apixaban, 46% were inappropriately underdosed. Patients inappropriately underdosed were younger (82.3 ± 8.4 vs. 85.9 ± 5.9 years, P < 0.0001) with less chronic renal disease (47 vs. 98%, P < 0.0001). However, these patients had higher rates of prior haemorrhagic events (18 vs. 10%, P = 0.01), clopidogrel use (11 vs. 3%, P = 0.0002), and apixaban prescription (74 vs. 50%, P < 0.0001).
conclusionWithin this large registry, DOACs were associated with inappropriate dosing in 18% of cases. Independent predictors of inappropriate dosing were high CHA2DS2VASc scores and older age. Moreover, 46% of patients treated with low-dose DOACs were inappropriately underdosed and more frequently in patients treated with apixaban.
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