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Article: Continuation of dabigatran therapy in "real-world" practice in Hong Kong

TitleContinuation of dabigatran therapy in "real-world" practice in Hong Kong
Authors
Issue Date2014
Citation
PLoS One, 2014, v. 9 n. 8, p. e101245 How to Cite?
AbstractBackground: Dabigatran, an oral direct thrombin inhibitor, possesses several advantages over warfarin that can in principle simplify the management of stroke prevention in atrial fibrillation (AF). Nonetheless it remains unclear whether these advantages can translate to clinical practice and encourage long-term therapy. The objective was to describe long-term dabigatran therapy for stroke prevention in AF and to identify risk factors for discontinuation of therapy. Methods and Results: We studied 467 consecutive Chinese patients (72±11 years, male: 53.8%) with a mean CHA2DS2-VASc score of 3.6 prescribed dabigatran for stroke prevention in AF from March 2010 to September 2013. Over a mean follow-up of 16 months, 101 patients (21.6%) permanently discontinued dabigatran. The mean time-to-discontinuation was 8 months. The most common reason for discontinuation was dyspepsia (30.7%), followed by other adverse events (17.8%) such as minor bleeding (8.9%), major gastrointestinal bleeding (7.9%), and intracranial hemorrhage (1%). Other reasons included dosing frequency (5.9%), fear of side effects (4.0%), lack of laboratory monitoring (1.0%), and cost (1.0%). Multivariable analysis revealed that low baseline estimated glomerular filtration rate (p = 0.02), absence of hypertension (p= 0.01), and prior use of a proton-pump inhibitor (p = 0.02) and H2-receptor blocker (p = 0.01) were independent predictors of drug discontinuation. In addition, there were altogether 9 ischemic strokes (1.5%/years), 3 intracranial hemorrhages (0.5%/year), and 24 major gastrointestinal bleedings (4.1%/year). Conclusion: Dabigatran discontinuation is very common amongst Chinese AF patients. This reveals a management gap in the prevention of stroke in AF. © 2014 Ho et al.
Persistent Identifierhttp://hdl.handle.net/10722/203064
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorHo, MHen_US
dc.contributor.authorHo, CWen_US
dc.contributor.authorCheung, Een_US
dc.contributor.authorChan, PHMen_US
dc.contributor.authorHai, JJen_US
dc.contributor.authorChan, KHen_US
dc.contributor.authorChan, EWen_US
dc.contributor.authorLeung, GKKen_US
dc.contributor.authorTse, HFen_US
dc.contributor.authorSiu, DCWen_US
dc.date.accessioned2014-09-19T11:29:25Z-
dc.date.available2014-09-19T11:29:25Z-
dc.date.issued2014en_US
dc.identifier.citationPLoS One, 2014, v. 9 n. 8, p. e101245en_US
dc.identifier.urihttp://hdl.handle.net/10722/203064-
dc.description.abstractBackground: Dabigatran, an oral direct thrombin inhibitor, possesses several advantages over warfarin that can in principle simplify the management of stroke prevention in atrial fibrillation (AF). Nonetheless it remains unclear whether these advantages can translate to clinical practice and encourage long-term therapy. The objective was to describe long-term dabigatran therapy for stroke prevention in AF and to identify risk factors for discontinuation of therapy. Methods and Results: We studied 467 consecutive Chinese patients (72±11 years, male: 53.8%) with a mean CHA2DS2-VASc score of 3.6 prescribed dabigatran for stroke prevention in AF from March 2010 to September 2013. Over a mean follow-up of 16 months, 101 patients (21.6%) permanently discontinued dabigatran. The mean time-to-discontinuation was 8 months. The most common reason for discontinuation was dyspepsia (30.7%), followed by other adverse events (17.8%) such as minor bleeding (8.9%), major gastrointestinal bleeding (7.9%), and intracranial hemorrhage (1%). Other reasons included dosing frequency (5.9%), fear of side effects (4.0%), lack of laboratory monitoring (1.0%), and cost (1.0%). Multivariable analysis revealed that low baseline estimated glomerular filtration rate (p = 0.02), absence of hypertension (p= 0.01), and prior use of a proton-pump inhibitor (p = 0.02) and H2-receptor blocker (p = 0.01) were independent predictors of drug discontinuation. In addition, there were altogether 9 ischemic strokes (1.5%/years), 3 intracranial hemorrhages (0.5%/year), and 24 major gastrointestinal bleedings (4.1%/year). Conclusion: Dabigatran discontinuation is very common amongst Chinese AF patients. This reveals a management gap in the prevention of stroke in AF. © 2014 Ho et al.-
dc.languageengen_US
dc.relation.ispartofPLoS Oneen_US
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.titleContinuation of dabigatran therapy in "real-world" practice in Hong Kongen_US
dc.typeArticleen_US
dc.identifier.emailChan, PHM: phmchan@hku.hken_US
dc.identifier.emailChan, KH: koonho@hku.hken_US
dc.identifier.emailChan, EW: ewchan@hku.hken_US
dc.identifier.emailLeung, GKK: gilberto@hku.hken_US
dc.identifier.emailTse, HF: hftse@hkucc.hku.hken_US
dc.identifier.emailSiu, DCW: cwdsiu@hkucc.hku.hken_US
dc.identifier.authorityChan, PHM=rp01864en_US
dc.identifier.authorityChan, KH=rp00537en_US
dc.identifier.authorityChan, EW=rp01587en_US
dc.identifier.authorityLeung, GKK=rp00522en_US
dc.identifier.authorityTse, HF=rp00428en_US
dc.identifier.authoritySiu, DCW=rp00534en_US
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1371/journal.pone.0101245en_US
dc.identifier.pmid25084117-
dc.identifier.scopuseid_2-s2.0-84905457264-
dc.identifier.hkuros235669en_US
dc.identifier.volume9en_US
dc.identifier.spagee101245en_US
dc.identifier.epagee101245en_US
dc.identifier.isiWOS:000339819800004-

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