Risk of Recurrent Ischemic Stroke with Unintended Low-Dose Oral Anticoagulant Therapy and Optimal Timing of Review

Autor: Eiji Kohmura, Shogo Tamura, Narihide Shinoda, Kazuyoshi Korosue, Shigeru Kose, Masafumi Mori
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Time Factors
Pyridones
Decreased serum creatinine
Administration
Oral
Renal function
Inappropriate Prescribing
030204 cardiovascular system & hematology
Kidney
Brain Ischemia
03 medical and health sciences
chemistry.chemical_compound
Drug Utilization Review
0302 clinical medicine
Japan
Recurrence
Risk Factors
Internal medicine
medicine
Humans
Drug Dosage Calculations
030212 general & internal medicine
Risk factor
Aged
Retrospective Studies
Aged
80 and over
Creatinine
business.industry
Incidence (epidemiology)
Body Weight
Rehabilitation
Anticoagulants
Retrospective cohort study
Stroke
Treatment Outcome
chemistry
Oral anticoagulant
Pyrazoles
Female
Surgery
Apixaban
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Intracranial Hemorrhages
Biomarkers
medicine.drug
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 27:1546-1551
ISSN: 1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.002
Popis: Background Direct oral anticoagulant (DOAC) dose is adjusted according to manufacturer's recommendations when introduced. However, subsequent changes from appropriate DOAC doses to “unintended” inappropriate low-dose DOAC (ILD) due to increased body weight (BW) or decreased serum creatinine concentration might be overlooked. We investigated outcomes in patients receiving appropriate DOAC, “intended” ILD, or unintended ILD, to determine the optimal review time for DOAC doses and associated factors. Methods This single-center, retrospective cohort study included inpatients receiving apixaban for stroke prevention between August 2015 and July 2017. Primary outcome was whether starting DOAC dose was selected according to manufacturer's recommendations and whether that dose remained appropriate thereafter. Secondary outcome was the incidence of recurrent ischemic stroke and intracranial bleeding during therapy. Average rates of change in BW, creatinine, and creatinine clearance (CrCl) were evaluated after hospitalization every 10 ± 3 days. Results During the study period, 120 patients received apixaban; 112 (93.3%) commenced appropriate DOAC doses, and 8 (6.7%) commenced intended ILD doses. Of the 112 patients on appropriate DOAC doses, 7 (6.3%) changed to unintended ILD doses because of increased BW (n = 4) or decreased creatinine (n = 3). The rate of recurrent ischemic stroke differed significantly between the appropriate DOAC dose and the intended or unintended ILD dose group (1.9% [2 of 105] versus 20.0% [3 of 15], P = .014). BW and renal function had stabilized after 20 ± 3 days posthospitalization. Conclusions Receiving ILD doses, especially unintended, might be a risk factor for recurrent ischemic stroke and DOAC dose should be reviewed around 20 ± 3 days posthospitalization.
Databáze: OpenAIRE
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