• Özcan Başaran, Volkan Dogan, Osman Beton, Mehmet Tekinalp, Ahmet Cağri Aykan, Ezgi Kalaycioğlu, Ismail Bolat, Onur Taşar, Özgen Şafak, Macit Kalcik, Mehmet Yaman, Sinan İnci, Bernas Altintaş, Sedat Kalkan, Cevat Kirma, Murat Biteker, and and Collaborators.
• Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas Department of Cardiology, Kahramanmaraş Necip Fazıl State Hospital, Kahramanmaraş Department of Cardiology,Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon Department of Cardiology,Fethiye State Hospital, Fethiye Department of Cardiology, Elazığ Education and Research Hospital, Elazığ Department of Cardiology, Burdur State Hospital, Burdur Department of Cardiology, İskilip Atıf Hoca State Hospital, Corum Department of Cardiology, Samsun Education and Research Hospital, Samsun Department of Cardiology, Aksaray State Hospital, Aksaray Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır Department of Cardiology, Gönen State Hospital, Gönen Kartal Kosuyolu Heart Education and Research Hospital, Kartal, Istanbul, Turkey.
• Medicine (Baltimore). 2016 Aug 1; 95 (35): e4672e4672.

AbstractThis study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance ≥50 mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50 mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of ≥3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients.

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