Anupdated pooled analysis of off-label under-and over-dosed direct oral anticoagulants in patients with atrial fibrillation Effectiveness and safety of DOACs off-label doses in AF
作者单位：绍兴文理学院附属医院
会议名称：《2023年浙江省医药学学术年会》
会议日期：1000年
学科分类：1007[医学-药学(可授医学、理学学位)] 1006[医学-中西医结合] 100706[医学-药理学] 100602[医学-中西医结合临床] 10[医学]
关 键 词：atrial fibrillation direct oral anticoagulants off-label stroke bleeding
摘 要：Introduction:Off-label under-and overdosed direct oral anticoagulants(DOACs) are commonly prescribed to patients with atrial fibrillation(AF),but real-world evidence on their effectiveness and safety is ***:MEDLINE,Embase,and Cochrane Library databases were systematically searched from 01 July 2020 to 28 February 2022,updating the previous systematic review with the same search strategy,that started from inception to 30 June 2020,for studies reporting effectiveness(ischemic stroke/systemic embolism and myocardial infarction) or safety(gastrointestinal or major bleeding,and death) outcomes of off-label doses of DOACs compared with on-label doses in AF patients.A random-effects meta-analysis was performed to estimate the pooled hazard ratio and 95% confidence intervals(CI).Subgroup analyses by specific DOACs and different geographic regions were also ***:Twenty-two studies reporting real world evidence on 223,057 patients were ***-label underdosed DOACs compared to on-label dose were not associated with any increased risk of stroke(HR 1.03,95%CI:0.88-1.17),but were associated with an increased risk of death(HR 1.26,95%CI:1.09-1.43),although risks varied based on the active *** other safety outcomes were associated withunderdosed *** significant differences could be observed by geographic region of *** to on-label DOACs,over-dosing increased the risk ofstroke(HR 1.17,95%CI:1.04-1.31),major bleeding(HR1.18,95%CI:1.05-1.31) and death(HR 1.19,95%CI:1.03-1.35).Risks varied across different geographic ***:Offlabel underdosed compared to on-label DOACs did not increase the risk of stroke,but they increased overall ***-dosed compared to on-label DOACs were associated with an increased risk of stroke,major bleeding,and *** studies are required to further examine this association,with greater attention to specific active ingredients and geographic settings.