Creatinine monitoring patterns in the setting of direct oral anticoagulant therapy for non-valvular atrial fibrillation

Guidelines and experts note that patients with atrial fibrillation require regular renal function monitoring to ensure safe use of direct oral anticoagulants (DOACs). Insufficient monitoring could lead to inappropriate dosing and adverse events. Our objective was to describe the frequency of insuffi...

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Published inJournal of thrombosis and thrombolysis Vol. 48; no. 3; pp. 500 - 505
Main Authors Gruca, Martin M., Li, Yun, Kong, Xiaowen, DeCamillo, Deborah, Kline-Rogers, Eva, Ali, Mona A., Kaatz, Scott, Dahu, Musa, Froehlich, James B., Barnes, Geoffrey D.
Format Journal Article
LanguageEnglish
Published New York Springer US 01.10.2019
Springer Nature B.V
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Abstract Guidelines and experts note that patients with atrial fibrillation require regular renal function monitoring to ensure safe use of direct oral anticoagulants (DOACs). Insufficient monitoring could lead to inappropriate dosing and adverse events. Our objective was to describe the frequency of insufficient creatinine monitoring among patients on DOACs, and to describe clinical factors associated with insufficient monitoring. We hypothesized that renal impairment would be associated with insufficient monitoring. A retrospective cohort study was performed with data from the Michigan Anticoagulant Quality Improvement Initiative. Patients were included if they initiated DOAC therapy for stroke prevention related to atrial fibrillation, remained on therapy for ≥ 1 year, and had baseline creatinine and weight measurements. Creatinine clearance (CrCl) was calculated via Cockcroft-Gault equation. Our outcome was the presence of insufficient creatinine monitoring, defined as: < 1 creatinine level/year for patients with CrCl > 50, or < 2 creatinine levels/year for patients with CrCl ≤ 50. Multivariable analysis was done via logistic regression. Study population included 511 patients. In overall, 14.0% of patients received insufficient monitoring. Among patients with CrCl > 50, 11.5% had < 1 creatinine level/year. Among patients with CrCl ≤ 50, 27.1% received < 2 creatinine levels/year. Baseline renal dysfunction was associated with a higher likelihood of insufficient creatinine monitoring (adjusted odds ratio 3.64, 95% confidence interval 1.81–7.29). This shows a significant gap in the monitoring of patients on DOACs—patients with renal impairment are already at higher risk for adverse events. Future studies are needed to describe the barriers in monitoring these patients and to identify how to optimally address them.
AbstractList Guidelines and experts note that patients with atrial fibrillation require regular renal function monitoring to ensure safe use of direct oral anticoagulants (DOACs). Insufficient monitoring could lead to inappropriate dosing and adverse events. Our objective was to describe the frequency of insufficient creatinine monitoring among patients on DOACs, and to describe clinical factors associated with insufficient monitoring. We hypothesized that renal impairment would be associated with insufficient monitoring. A retrospective cohort study was performed with data from the Michigan Anticoagulant Quality Improvement Initiative. Patients were included if they initiated DOAC therapy for stroke prevention related to atrial fibrillation, remained on therapy for ≥ 1 year, and had baseline creatinine and weight measurements. Creatinine clearance (CrCl) was calculated via Cockcroft-Gault equation. Our outcome was the presence of insufficient creatinine monitoring, defined as: < 1 creatinine level/year for patients with CrCl > 50, or < 2 creatinine levels/year for patients with CrCl ≤ 50. Multivariable analysis was done via logistic regression. Study population included 511 patients. In overall, 14.0% of patients received insufficient monitoring. Among patients with CrCl > 50, 11.5% had < 1 creatinine level/year. Among patients with CrCl ≤ 50, 27.1% received < 2 creatinine levels/year. Baseline renal dysfunction was associated with a higher likelihood of insufficient creatinine monitoring (adjusted odds ratio 3.64, 95% confidence interval 1.81–7.29). This shows a significant gap in the monitoring of patients on DOACs—patients with renal impairment are already at higher risk for adverse events. Future studies are needed to describe the barriers in monitoring these patients and to identify how to optimally address them.
Guidelines and experts note that patients with atrial fibrillation require regular renal function monitoring to ensure safe use of direct oral anticoagulants (DOACs). Insufficient monitoring could lead to inappropriate dosing and adverse events. Our objective was to describe the frequency of insufficient creatinine monitoring among patients on DOACs, and to describe clinical factors associated with insufficient monitoring. We hypothesized that renal impairment would be associated with insufficient monitoring. A retrospective cohort study was performed with data from the Michigan Anticoagulant Quality Improvement Initiative. Patients were included if they initiated DOAC therapy for stroke prevention related to atrial fibrillation, remained on therapy for ≥ 1 year, and had baseline creatinine and weight measurements. Creatinine clearance (CrCl) was calculated via Cockcroft-Gault equation. Our outcome was the presence of insufficient creatinine monitoring, defined as: < 1 creatinine level/year for patients with CrCl > 50, or < 2 creatinine levels/year for patients with CrCl ≤ 50. Multivariable analysis was done via logistic regression. Study population included 511 patients. In overall, 14.0% of patients received insufficient monitoring. Among patients with CrCl > 50, 11.5% had < 1 creatinine level/year. Among patients with CrCl ≤ 50, 27.1% received < 2 creatinine levels/year. Baseline renal dysfunction was associated with a higher likelihood of insufficient creatinine monitoring (adjusted odds ratio 3.64, 95% confidence interval 1.81-7.29). This shows a significant gap in the monitoring of patients on DOACs-patients with renal impairment are already at higher risk for adverse events. Future studies are needed to describe the barriers in monitoring these patients and to identify how to optimally address them.
Author Barnes, Geoffrey D.
Gruca, Martin M.
Li, Yun
Ali, Mona A.
Dahu, Musa
Froehlich, James B.
DeCamillo, Deborah
Kaatz, Scott
Kline-Rogers, Eva
Kong, Xiaowen
AuthorAffiliation 1 Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan Medical Center, Ann Arbor, MI, USA
4 Beaumont Hospital, Royal Oak, MI, USA
5 Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA
2 Department of Internal Medicine, McGaw Medical Center, Northwestern University, 676 North St. Clair Street, Arkes Suite 2330, Chicago, IL 60611, USA
3 Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
6 Spectrum Health System, Grand Rapids, MI, USA
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Keywords Creatinine
Drug monitoring
Kidney diseases
Atrial fibrillation
Factor Xa inhibitors
Language English
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Notes Concept and design: MMG, YL, EKR, MAA, SK, MD, JBF, GDB. Acquisition, analysis, or interpretation of data: YL, XK, DD. Drafting of the manuscript: MMG. Critical revision of the manuscript for important intellectual content: MMG, YL, XK, DD, EKR, MAA, SK, MD, JBF, GDB. Statistical analysis: YL, XK. Obtained funding: JBF, GDB Administrative, technical, or material support: MMG, YL, XK, DD, EKR, MAA, SK, MD, JBF, GDB. Supervision: GDB
Author contributions
ORCID 0000-0002-2705-4821
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Snippet Guidelines and experts note that patients with atrial fibrillation require regular renal function monitoring to ensure safe use of direct oral anticoagulants...
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StartPage 500
SubjectTerms Aged
Anticoagulants
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Cardiac arrhythmia
Cardiology
Creatinine
Creatinine - blood
Creatinine - pharmacokinetics
Drug Monitoring - methods
Drug Monitoring - standards
Factor Xa Inhibitors - adverse effects
Factor Xa Inhibitors - therapeutic use
Female
Fibrillation
Health risk assessment
Hematology
Humans
Kidney Diseases - complications
Male
Medicine
Medicine & Public Health
Michigan
Middle Aged
Population studies
Quality control
Renal function
Retrospective Studies
Stroke
Stroke - prevention & control
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Title Creatinine monitoring patterns in the setting of direct oral anticoagulant therapy for non-valvular atrial fibrillation
URI https://link.springer.com/article/10.1007/s11239-019-01883-0
https://www.ncbi.nlm.nih.gov/pubmed/31111434
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Volume 48
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