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\begin{document}

\title{Prevalence, Contemporary Trends and Associated Factors of Potentially
Inappropriate Prescription of Edoxaban in Real-world Clinical Practice:
A Subanalysis of the SUNSHINE Registry}



\author[1]{Shujuan Zhao}%
\author[2]{Hengfen Dai}%
\author[3]{Jiaxin Chen}%
\author[4]{Ming Ni}%
\author[5]{Wenxing Peng}%
\author[1]{Xiaoyu  Li}%
\author[1]{Fen Li}%
\author[1]{Boya Chen}%
\author[1]{Haixia Cai}%
\author[1]{Yinping Liu}%
\author[6]{Zhichun Gu}%
\author[1]{Song Du}%
\author[5]{PeiZhi Ma}%
\affil[1]{Henan Provincial People’s Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University}%
\affil[2]{Fujian Medical University Affiliated Fuzhou First Hospital}%
\affil[3]{Ningde Municipal Hospital Affiliated to Ningde Normal University}%
\affil[4]{Fuwai Central China Cardiovascular Hospital}%
\affil[5]{Affiliation not available}%
\affil[6]{Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital}%


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  \date{May 25, 2024}


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\begin{abstract}
Aim: As the non-vitamin K antagonist oral anticoagulant (NOAC) most
recently approved in China, data pertaining to clinical edoxaban use are
still scarce. This study investigated the prevalence of and contemporary
trends in edoxaban prescription among Chinese patients as well as
factors associated with its inappropriate use in a multi-center registry
of patients treated in real-world clinical practice. Methods: This
real-world, prospective, multicenter, and non-interventional study
included 1005 inpatients treated with edoxaban. According to National
Medical Products Administration and European Heart Rhythm Association
guidelines, edoxaban therapy was determined to be appropriate or
inappropriate in each case. Results: The median patient age was 70.0
years (interquartile range, 61.0--78.0 years), and 46.3\% were women.
Overall, 456 (45.4\%) patients received inappropriate edoxaban therapy,
and common issues included an inappropriately low (183, 18.2\%) or high
(73, 7.3\%) dosage, wrong drug selection (109, 10.8\%), unreasonable
off-label use (49, 4.9\%), incorrect administration timing (16, 1.6\%),
and contraindication due to other medications (27, 2.7\%). Several
factors (e.g., age, weight, kidney function, anemia, and bleeding
history) were associated with an increased risk of inappropriate
edoxaban therapy, whereas factors associated with cardiovascular
specialties (e.g., hospitalized in cardiovascular department and
dronedarone or amiodarone use) decreased this risk. Conclusion: In this
real-world study, 45.4\% of patients received an inappropriate treatment
with edoxaban. Multiple clinical characteristics can help identify
patients who should receive edoxaban. Further development and
implantation of educational activities and management strategies are
needed to ensure the correct use of edoxaban.%
\end{abstract}%



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