Prescription frequency and predictors for the use of novel direct oral anticoagulants for secondary stroke prevention in the first year after their marketing in Europe--a multicentric evaluation.

Abstract

BACKGROUND:

Direct oral anticoagulants (DOAC) are alternatives to the use of vitamin K antagonists (VKA) as oral anticoagulant therapies to prevent stroke in patients with atrial fibrillation.

AIMS:

We assembled a representative secondary prevention cohort from four tertiary care stroke centers to identify factors that independently influence therapeutic decision making 1) not to anticoagulate with either VKA or DOAC and 2) to use DOAC if the patient appears suitable for oral anticoagulant therapy.

METHODS:

We identified all patients discharged with the diagnoses 'ischemic stroke' (ICD-10 code I63) or 'transient ischemic attack' (G45) in combination with 'atrial fibrillation' (I48) during 1 year. We performed binary logistic regression analyses to identify factors independently influencing the aforementioned decisions.

RESULTS:

Our cohort comprised 758 patients. At discharge from the stroke service, 374 patients (49·3%) received oral anticoagulant therapy. Older age, severe stroke, poor recovery in the acute phase, and higher serum creatinine were independent factors to withhold oral anticoagulant therapy, whereas prior oral anticoagulant therapy favored the decision to anticoagulate. Among patients who were anticoagulated, prescription was balanced for VKA (50·3%) and DOAC (49·7%). Renal function and prior oral anticoagulant therapies were the most important factors in this decision.

CONCLUSIONS:

Shortly after their marketing, DOAC are used as frequently as VKA for secondary stroke prevention in patients with atrial fibrillation. The decision between VKA and DOAC is mainly determined by the patient's renal function and the absence or presence of prior oral anticoagulant therapy.

• Authors: Sebastian Luger, Carina Hohmann, Peter Kraft, Ramona Halmer, Ignaz Gunreben, Tobias Neumann-Haefelin, Christoph Kleinschnitz, Silke Walter, Veronika Haripyan, Helmuth Steinmetz, Christian Foerch, Waltraud Pfeilschifter
• Journal: International journal of stroke : official journal of the International Stroke Society (Int J Stroke) Vol. 9 Issue 5 Pg. 569-75 (Jul 2014) ISSN: 1747-4949 [Electronic] United States
• PMID: 24828272 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2014 World Stroke Organization.

Chemical References

• Anticoagulants
• Creatinine

Topics

• Administration, Oral
• Age Factors
• Aged
• Anticoagulants (administration & dosage)
• Atrial Fibrillation (drug therapy, epidemiology, physiopathology)
• Brain Ischemia (epidemiology, physiopathology, prevention & control)
• Cohort Studies
• Creatinine (blood)
• Europe
• Female
• Humans
• Ischemic Attack, Transient (epidemiology, physiopathology, prevention & control)
• Kidney (physiopathology)
• Male
• Marketing
• Practice Patterns, Physicians' (statistics & numerical data)
• Retrospective Studies
• Secondary Prevention (methods)
• Severity of Illness Index
• Stroke (epidemiology, physiopathology, prevention & control)
• Tertiary Care Centers