1354The effect of non-recommended dosing of non-vitamin K antagonist oral anticoagulants (NOACs) on 1-year mortality in patients with newly diagnosed AF? Results from the GARFIELD-AF registry
Bibliographic record
Abstract
Background: The recommended doses for a NOAC to prevent stroke and systemic embolism (SE) in patients with non-valvular atrial fibrillation (AF) are specified in the prescribing information. Prospective observational studies provide an opportunity to evaluate whether the actual dosing of these drugs in real-life conforms with the approved dosing. Methods: This analysis assesses the impact of NOAC dosing (i.e., recommended vs. non-recommended) on all-cause mortality at 1 year in patients in newly diagnosed AF. Of patients enrolled consecutively into the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) between Apr-2013 and Sep-2015, 10,417 from 35 countries were eligible for this analysis: rivaroxaban (n=4490, 43.1%), apixaban (n=3283, 31.5%), dabigatran (n=2359, 22.6%) and edoxaban (n=285, 2.7%). Recommended dosing was determined according to differing country criteria, including: impaired kidney function and/or low body weight (≤60 kg) or age ≥80 yrs. Results: Compared with patients who received the recommended dose, non-recommended dosing according to country-specific guidelines was associated with a higher all-cause mortality. The hazard ratios were: 1.51, 95% confidence interval 1.16 to 1.96 (for dosing below recommendations) and 1.57, 95% CI 0.97 to 2.56 (for dosing above recommendations) after adjusting for age, sex, ethnicity, smoking, alcohol consumption, diabetes, hypertension, history of bleeding, history of stroke/TIA, heart failure, vascular disease, and AF type. Prescribing patterns according to country-specific guidelines are reported in the figure. More than 70% of patients received the correct dose of rivaroxaban, apixaban or dabigatran. Treatment below the recommended doses with rivaroxaban or apixaban was more common in patients from Japan (38.0% [rivaroxaban], 39.4% [apixaban]) than other regions (17.8% [rivaroxaban], 24.0% [apixaban]). Patients on edoxaban were more likely to receive doses below the recommendations compared with the other NOACs; approximately two-thirds of these patients were from Japan. Few patients (3.6%, overall) were treated above the recommended doses. Of those who were treated over the recommended doses, 67.7% had moderate-to severe CKD. By comparison, 8.9% of patients on recommended doses and 7.1% on non-recommended low-doses had moderate-to severe CKD.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".