Abstract:
OBJECTIVE:To evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulants (NOACs) according to label in patients with non-valvular atrial fibrillation (NVAF) in the UK. DESIGN:Population-based cross-sectional study. SETTING:UK primary care. POPULATION:30 467 patients with NVAF and a first prescription for apixaban, dabigatran or rivaroxaban between January 2011 and December 2016. MAIN OUTCOME MEASURES:Percentage of patients prescribed a NOAC dose according to the European Union (EU) labels (appropriately dosed), and not according to the EU labels (inappropriately dosed-including both underdosed and overdosed patients); percentage of patients prescribed an initial NOAC dose according to renal function status. RESULTS:A total of 15 252 (50.1%) patients started NOAC therapy on rivaroxaban, 10 834 (35.6%) on apixaban and 4381 (14.4%) on dabigatran. Among patients starting NOAC therapy on rivaroxaban, 17.3% were eligible to receive a reduced dose compared with 12.8% of patients starting on apixaban and 53.8% of patients starting on dabigatran. The majority of patients were prescribed an appropriate dose according to the EU labels: apixaban 74.9 %, dabigatran, 74.4%; rivaroxaban, 84.2%. Underdosing occurred in 21.6% (apixaban), 8.7% (dabigatran), 9.1% (rivaroxaban). Overdosing was more frequent for dabigatran (16.9%) than for rivaroxaban (6.6%) or apixaban (3.5%). There was a trend towards dose reduction with increasing renal impairment. Among patients with severe renal impairment, the majority received a reduced dose NOAC: apixaban, 91.1%, dabigatran, 80.0%, rivaroxaban, 83.0%. CONCLUSION: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. Research into the patient characteristics that may influence inappropriate underdosing of NOACs in UK primary care is warranted.
journal_name
BMJ Openjournal_title
BMJ openauthors
García Rodríguez LA,Martín-Pérez M,Vora P,Roberts L,Balabanova Y,Brobert G,Fatoba S,Suzart-Woischnik K,Schaefer B,Ruigomez Adoi
10.1136/bmjopen-2019-031341subject
Has Abstractpub_date
2019-09-20 00:00:00pages
e031341issue
9issn
2044-6055pii
bmjopen-2019-031341journal_volume
9pub_type
杂志文章相关文献
BMJ Open文献大全abstract:OBJECTIVE:The aim of this pilot study was to determine risk factors, including Staphylococcus aureus nasal carriage, for dermatitis in submariners during a submarine patrol. PARTICIPANTS AND METHODS:36 submariners undertaking a submerged 6-week patrol participated in the study. Severity of dermatitis and its impact wa...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-010975
更新日期:2016-06-02 00:00:00
abstract:OBJECTIVES:There is uncertainty about when the first cases of COVID-19 appeared in Spain. We aimed to determine whether influenza diagnoses masked early COVID-19 cases and estimate numbers of undetected COVID-19 cases. DESIGN:Time-series study of influenza and COVID-19 cases, 2010-2020. SETTING:Primary care, Cataloni...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-039369
更新日期:2020-07-29 00:00:00
abstract:OBJECTIVES:To evaluate the utility of different symptoms, alone or combined, presented to primary care for an adult brain tumour diagnosis. DESIGN AND SETTING:Matched case-control study, using the data from Clinical Practice Research Datalink (2000-2014) from primary care consultations in the UK. METHOD:All presentat...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-029686
更新日期:2019-08-30 00:00:00
abstract:OBJECTIVE:Examine the safety of menstrual cups against sanitary pads and usual practice in Kenyan schoolgirls. DESIGN:Observational studies nested in a cluster randomised controlled feasibility study. SETTING:30 primary schools in a health and demographic surveillance system in rural western Kenya. PARTICIPANTS:Mens...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2016-015429
更新日期:2017-05-04 00:00:00
abstract:OBJECTIVE:To explore whether a preconsultation web-based intervention enables patients with diabetes to articulate their agenda in a consultation in the hospital outpatient clinic with their diabetologist. METHODS AND DESIGN:A qualitative study embedded in a pragmatic pilot randomised controlled trial. SETTING:Two ci...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2018-026588
更新日期:2019-06-14 00:00:00
abstract:INTRODUCTION:Depression and alcohol use disorders are international public health priorities for which there is a substantial treatment gap. Brief mental health interventions delivered by lay health workers in primary care services may reduce this gap. There is limited economic evidence assessing the cost-effectiveness...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-026973
更新日期:2019-05-14 00:00:00
abstract:OBJECTIVES:HIV prevention efforts, particularly among men who have sex with men (MSM), have not achieved maximum effectiveness. A survey of MSM in Ottawa, Canada was completed to ascertain whether there were differences in how the perceived HIV status of participants and their partners influenced sexual practices. MET...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-005065
更新日期:2014-09-19 00:00:00
abstract:OBJECTIVES:To evaluate the cost-effectiveness of immediate treatment with ranibizumab in patients with neovascular age-related macular degeneration (nAMD) with good (better than 6/12) starting visual acuity compared with current UK clinical guidance of waiting until vision falls below 6/12 to begin treatment, using rea...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2014-006535
更新日期:2015-05-05 00:00:00
abstract:INTRODUCTION:Surgery is one of the primary treatments for lung cancer. The postoperative symptom burden experienced by patients with lung cancer is substantial, seriously delaying their recovery from surgery and impairing their quality of life. Patient-reported outcome (PRO)-based symptom management is increasingly reg...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-030041
更新日期:2019-08-26 00:00:00
abstract:INTRODUCTION:Monitoring and reduction of aversive tension is a core issue in dialectical behaviour therapy of patients. It has been shown that aversive tension is increased in adult borderline personality disorder and is linked to low emotion labelling ability. However, until now there is no documented evidence that pa...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-004703
更新日期:2014-04-23 00:00:00
abstract:INTRODUCTION:Sepsis is defined as detrimental immune response to an infection. This overwhelming reaction often abolishes a normal reconstitution of the immune cell homeostasis that in turn increases the risk for further complications. Recent studies revealed a favourable impact of ketone bodies on resolution of inflam...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-038532
更新日期:2020-07-08 00:00:00
abstract:INTRODUCTION:Harm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary ca...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-013842
更新日期:2017-06-23 00:00:00
abstract:INTRODUCTION:Opioid use disorder (OUD) is characterised by the fifth Edition of the Diagnostic and Statistics Manual as a problematic pattern of opioid use (eg, fentanyl, heroin, oxycodone) that leads to clinically significant impairment. OUD diagnoses have risen substantially over the last decade, and treatment servic...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022267
更新日期:2018-10-17 00:00:00
abstract:OBJECTIVES:To promote gender diversity and equity in higher education, Athena Scientific Women's Academic Network (SWAN) supports and recognises higher education institutions (HEI) in advancing the careers of women through charter commitment, awards, training and advocacy since 2005. Most evaluation studies, however, a...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-032915
更新日期:2020-02-12 00:00:00
abstract:INTRODUCTION:Two of the most acute and feared complications in type 1 diabetes (T1D) are hypoglycaemia and severe hypoglycaemia (SH). While impaired awareness of hypoglycaemia (IAH) can lead to SH with cognitive and motivational barriers implicated, the available education does not integrate behavioural change techniqu...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-030370
更新日期:2019-11-14 00:00:00
abstract:OBJECTIVES:Our aims were to assess the relationship between workplace violence, job satisfaction, burnout, organisational support and turnover intention, and to explore factors associated with turnover intention among nurses in Chinese tertiary hospitals. METHODS:The purposive sampling method was used to collect data ...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2017-019525
更新日期:2018-06-09 00:00:00
abstract:PURPOSE:Acute-on-chronic liver failure (ACLF) is a clinical syndrome with high short-term mortality, unclear mechanism and controversial diagnosis criteria. The Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study has been conducted in China to fill the gaps. In the first phase (the CATCH-LIFE investigation cohort...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-037793
更新日期:2021-01-08 00:00:00
abstract:OBJECTIVE:To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. DESIGN:Systematic review. SETTING:Electronic databases (Medline, Embase, ASS...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-019573
更新日期:2018-06-19 00:00:00
abstract:SETTING:The State of Qatar has had one of the highest COVID-19 infection rates globally and has used state-managed quarantine and isolation centres to limit the spread of infection. Quarantine and isolation have been shown to negatively affect the mental health of individuals. Qatar has a unique population, with around...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-045794
更新日期:2021-01-31 00:00:00
abstract:INTRODUCTION:Ambient air pollution is a global environmental problem, which causes adverse health effects and premature deaths worldwide. Although regular exercise and physical activity have evident health benefits, the influence of long-term air pollution exposure during regular outdoor running has not been definitive...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-040529
更新日期:2020-12-10 00:00:00
abstract:OBJECTIVES:Malignant melanoma has high morbidity and mortality rates. Early diagnosis improves prognosis. Clinical prediction rules (CPRs) can be used to stratify patients with symptoms of suspected malignant melanoma to improve early diagnosis. We conducted a systematic review of CPRs for melanoma diagnosis in ambulat...
journal_title:BMJ open
pub_type: 杂志文章,评审
doi:10.1136/bmjopen-2016-014096
更新日期:2017-03-06 00:00:00
abstract:INTRODUCTION:Diabetic macular oedema (DMO) and proliferative diabetic retinopathy (PDR) are the major causes of sight loss in people with diabetes. Due to the increased prevalence of diabetes, the workload related to these complications is increasing making it difficult for Hospital Eye Services (HSE) to meet demands. ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-027795
更新日期:2019-06-28 00:00:00
abstract:OBJECTIVES:To investigate whether life event stress was associated with greater psychological distress and poorer quality of life in older individuals with chronic obstructive pulmonary disease (COPD), in comparison with their counterparts without COPD. DESIGN:Cross-sectional study. PARTICIPANTS:A population-based sa...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001674
更新日期:2012-11-19 00:00:00
abstract:OBJECTIVES:Most studies reporting evidence of adverse effects of lead and cadmium on the ability to balance have been conducted in high-exposure groups or have included adults. The effects of prenatal exposure have not been well studied, nor have the effects in children been directly studied. The aim of the study was t...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-009635
更新日期:2015-12-30 00:00:00
abstract::Objectives Diagnoses-specific sickness certification guidelines were recently introduced in Sweden. The aim of this study was to investigate to which extent general practitioners (GPs) used these guidelines and how useful they found them, 1 year after introduction. Design A cross-sectional questionnaire study. A comp...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2011-000303
更新日期:2011-12-20 00:00:00
abstract:OBJECTIVES:South Africa has achieved significant success with its tobacco control policy. Between 1994 and 2012, the real price of cigarettes increased by 229%, while regular smoking prevalence decreased from about 31% to 18.2%. METHODS:Cigarette prices and socioeconomic variables are used to examine the determinants ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011076
更新日期:2016-07-18 00:00:00
abstract:INTRODUCTION:The transfer of patient care between the intensive care unit (ICU) and the hospital ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to hospital ward by documenting (1) patient, family and provider experiences related to ICU tran...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2015-007913
更新日期:2015-07-08 00:00:00
abstract:OBJECTIVES:Scientific literacy is assumed necessary for appraising the reliability of health claims. Using a national science achievement test, we explored whether students located at the lower quartile on the latent trait (scientific literacy) scale were likely to identify a health claim in a fictitious brief news rep...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-028781
更新日期:2019-10-18 00:00:00
abstract:OBJECTIVES:Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of viol...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-021389
更新日期:2018-09-11 00:00:00
abstract:INTRODUCTION:Down syndrome results in neuromotor impairment that affects selective motor control, compromising the acquisition of motor skills and functional independence. The aim of the proposed study is to evaluate and compare the effects of multiple-monopolar anodal transcranial direct current stimulation and sham s...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2017-016260
更新日期:2017-08-11 00:00:00