Article type
Abstract
Background: The coronavirus pandemic triggered creation of clinical practice guidelines (CPGs) by professional medical associations. Quality of Russian CPGs has been scarcely studied. Direct oral anticoagulants (DOACs) in COVID-19 patients were problematic for evidence-based recommendations.
The objective: To assess DOAC consumption in Russia during COVID-19 pandemic and quality of national CPGs that recommended their use.
Methods: We searched Russian databases for CPGs, published in 2020-23. We identified seven relevant documents. Three authors analysed Russian CPGs using AGREE II instrument. We calculated DOAC consumption in Defined Daily Doses (DDDs) in all officially registered COVID-19 patients in 2020–2022 and compared it to CPG recommendations.
Results: We gave the highest scores to domains of scope and purpose (from 62.98% to 100%) and clarity of presentation (from 96.30% to 100%); the lowest – to stakeholder involvement (33.33% to 64.81%), rigour of development (from 0% to 49.31%), applicability (from 23.61% to 50%), and editorial independence (from 0% to 50%). Total assessment scores did not exceed 70%. According to CPGs, the consumption of apixaban and rivaroxaban should be 15 DDD (30-day course of therapy), or 22.5 DDD (45-day course of therapy) per patient. Hypothetical apixaban consumption by a COVID-19 patient in the Russian Federation in 2020 and 2021 was comparable with CPGs recommendations (in 2020 – 26.59 DDD; in 2021 – 15.75 DDD per patient), in 2022 it was lower: 10.67 DDD.
In 2020, rivaroxaban consumption per patient in Russia was 26.59, meeting CPGs recommendations; in 2021 and 2022 it decreased to 7.87 and 5.48 DDD.
Conclusions:
1.Assessment scores of AGREE II instrument were highest for domains scope and purpose and clarity of presentation. Domains of concern were rigor of development and editorial independence.
2.During the coronavirus pandemic, the highest level of DOAC consumption (DDD) was in 2020, exceeding the recommendations of Russian CPGs for DOACs. By 2022, DOAC consumption decreased with an increase in the share of apixaban in the structure of DOAC consumption.
3.In 2021, the hypothetical dose of apixaban per patient with COVID-19 corresponded to the recommended 30-day course of prophylaxis by national CPGs.
The objective: To assess DOAC consumption in Russia during COVID-19 pandemic and quality of national CPGs that recommended their use.
Methods: We searched Russian databases for CPGs, published in 2020-23. We identified seven relevant documents. Three authors analysed Russian CPGs using AGREE II instrument. We calculated DOAC consumption in Defined Daily Doses (DDDs) in all officially registered COVID-19 patients in 2020–2022 and compared it to CPG recommendations.
Results: We gave the highest scores to domains of scope and purpose (from 62.98% to 100%) and clarity of presentation (from 96.30% to 100%); the lowest – to stakeholder involvement (33.33% to 64.81%), rigour of development (from 0% to 49.31%), applicability (from 23.61% to 50%), and editorial independence (from 0% to 50%). Total assessment scores did not exceed 70%. According to CPGs, the consumption of apixaban and rivaroxaban should be 15 DDD (30-day course of therapy), or 22.5 DDD (45-day course of therapy) per patient. Hypothetical apixaban consumption by a COVID-19 patient in the Russian Federation in 2020 and 2021 was comparable with CPGs recommendations (in 2020 – 26.59 DDD; in 2021 – 15.75 DDD per patient), in 2022 it was lower: 10.67 DDD.
In 2020, rivaroxaban consumption per patient in Russia was 26.59, meeting CPGs recommendations; in 2021 and 2022 it decreased to 7.87 and 5.48 DDD.
Conclusions:
1.Assessment scores of AGREE II instrument were highest for domains scope and purpose and clarity of presentation. Domains of concern were rigor of development and editorial independence.
2.During the coronavirus pandemic, the highest level of DOAC consumption (DDD) was in 2020, exceeding the recommendations of Russian CPGs for DOACs. By 2022, DOAC consumption decreased with an increase in the share of apixaban in the structure of DOAC consumption.
3.In 2021, the hypothetical dose of apixaban per patient with COVID-19 corresponded to the recommended 30-day course of prophylaxis by national CPGs.