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Impact of Direct Oral Anticoagulant Concentration on Clinical Outcomes in Asian Patients with Atrial Fibrillation.
Lin, Shin-Yi; Tang, Sung-Chun; Kuo, Ching-Hua; Ho, Li-Ting; Liu, Yen-Bin; Peng, Yu-Fong; Tsai, Li-Kai; Huang, Chih-Fen; Jeng, Jiann-Shing.
Afiliación
  • Lin SY; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
  • Tang SC; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
  • Kuo CH; Department of Neurology, Stroke Center, National Taiwan University Hospital, Taipei, Taiwan.
  • Ho LT; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
  • Liu YB; Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
  • Peng YF; Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
  • Tsai LK; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
  • Huang CF; Department of Neurology, Stroke Center, National Taiwan University Hospital, Taipei, Taiwan.
  • Jeng JS; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Clin Pharmacol Ther ; 114(1): 230-238, 2023 07.
Article en En | MEDLINE | ID: mdl-37132484
A real-world association between direct oral anticoagulant (DOAC) concentration and clinical outcomes among Asian patients with atrial fibrillation (AF) is reported herein. Patients with AF aged ≥ 20 years who used DOAC for ≥ 3 days were enrolled. Trough and peak DOAC concentrations were measured and compared with the expected range reported in clinical trials. The Cox proportional hazard model was used to investigate the association between concentration and outcomes. From January 2016 to July 2022, a total of 859 patients were enrolled. Among them, 22.5%, 24.7%, 36.4%, and 16.4% were on dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. Compared with clinical trials, the proportion of DOAC concentrations higher or lower than the expected range were 9.0% and 14.6% for trough, respectively, and 20.9% and 12.1% for peak, respectively. The average follow-up duration was 2.4 ± 1.6 years. The incidence of stroke and systemic thromboembolism (SSE) was 1.31 per 100-person years, and low trough concentration predicted SSE (hazard ratio (HR) = 2.78 (1.20, 6.46)). The incidence of major bleeding was 1.64 per 100-person years, and high trough was associated with major bleeding (HR = 2.63 (1.09, 6.39)). The association between peak concentration and SSE or major bleeding was nonsignificant. Off-label underdosing (odds ratio (OR) = 2.69 (1.70, 4.26)), once daily DOAC dosing (OR = 3.22 (2.07, 5.01)), and high creatinine clearance (OR = 1.02 (1.01, 1.03)) caused low trough concentration. Contrarily, congestive heart failure was significantly associated with high trough concentration (OR = 1.71 (1.01, 2.92)). In conclusion, trough DOAC concentration measurements should be considered among patients at risk of out-of-expected range DOAC concentrations.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Accidente Cerebrovascular Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Clin Pharmacol Ther Año: 2023 Tipo del documento: Article País de afiliación: Taiwán Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Accidente Cerebrovascular Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Clin Pharmacol Ther Año: 2023 Tipo del documento: Article País de afiliación: Taiwán Pais de publicación: Estados Unidos