Journal article : Review
Correct dosing, adherence and persistence of DOACs in atrial fibrillation and chronic kidney disease: a systematic review and meta-analysis
- Abstract:
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Background Chronic kidney disease (CKD) and atrial fibrillation (AF) are increasing in prevalence globally and share common risk factors.
Our aim was to characterise real-world evidence on direct oral anticoagulant (DOAC) prescribing for people with AF and CKD, in terms of adherence, persistence and renal dose titration.Methods PubMed, EMBASE and CINAHL were searched from inception to June 2022. Our search terms included a combination of Medical Subject Headings (MeSH) terms and keywords including ‘atrial fibrillation’, ‘chronic kidney disease’, ‘adherence’, ‘persistence’, ‘direct oral anticoagulants’ and ‘dosing’. Data extraction and quality assessment were undertaken by two reviewers independently. Meta-analyses for pooled estimates were performed using DerSimonian and Laird random-effects models. Age, sex, diabetes, hypertension and heart failure were chosen as variables of interest.
Results From 19 studies, a total of 252 117 patients were included with CKD and AF. Meta-analysis was only possible in seven studies with 128 406 patients, five on DOAC dose titration and two on adherence. There were insufficient studies on persistence. Our meta-analysis of dosing showed that 68% of patients with CKD and AF had correct dosing. There was no evidence to show any association between correct DOAC dosing and variables of interest. Overall, 67% of patients were DOAC adherent.
Conclusion Adherence and correct dosing of DOACs were suboptimal compared with other medications in the pooled studies with respect to CKD and AF. Thus, further research is required as the lack of generalisation of findings is a rate-limiting factor for improved DOAC management in AF and CKD.
PROSPERO registration number CRD;42022344491.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 2.7MB, Terms of use)
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- Publisher copy:
- 10.1136/openhrt-2023-002340
Authors
- Publisher:
- BMJ Publishing Group
- Journal:
- Open Heart More from this journal
- Volume:
- 10
- Issue:
- 2
- Article number:
- e002340
- Place of publication:
- England
- Publication date:
- 2023-07-06
- Acceptance date:
- 2023-06-16
- DOI:
- EISSN:
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2053-3624
- Pmid:
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37419525
- Language:
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English
- Keywords:
- Subtype:
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Review
- Pubs id:
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1492376
- Local pid:
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pubs:1492376
- Deposit date:
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2023-09-08
Terms of use
- Copyright holder:
- Emanuel et al.
- Copyright date:
- 2023
- Rights statement:
- © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.
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