Ischemic stroke and dose adjustment of oral Factor Xa inhibitors in patients with atrial fibrillation.
Administration, Oral
Aged
Aged, 80 and over
Atrial Fibrillation
/ complications
Factor Xa Inhibitors
/ administration & dosage
Female
Follow-Up Studies
Guideline Adherence
/ standards
Humans
Ischemic Stroke
/ etiology
Male
Outcome Assessment, Health Care
Practice Guidelines as Topic
/ standards
Registries
Severity of Illness Index
Sex Factors
Atrial fibrillation
Direct oral anticoagulants
Dose reduction
Plasma levels
Stroke
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
21
02
2020
accepted:
13
03
2020
revised:
11
03
2020
pubmed:
25
3
2020
medline:
13
4
2021
entrez:
25
3
2020
Statut:
ppublish
Résumé
Oral Factor Xa inhibitors for the prevention of stroke in atrial fibrillation require dose adjustment based on certain clinical criteria, but the off-label use of the reduced doses is common. Data from an observational registry including patients admitted with acute cerebral ischemia while taking oral Factor Xa inhibitors for atrial fibrillation between April 2016 and December 2018 were investigated. The dose regimen of the Xa inhibitor was classified as "appropriate", "underdosed" and "overdosed" in conformity with the European Medicines Agency labelling. The effect of underdosing on the functional factor Xa plasma level on admission, the clinical stroke severity and the functional outcome after 3 months were investigated. 254 patients with cerebral ischemia while on Factor Xa inhibitors were included. The dose regimen of the Factor Xa inhibitor was appropriate in 166 patients (65%), underdosed in 67 patients (26%) and overdosed in 21 patients (8%). Underdosing was associated with female sex, diabetes mellitus and higher CHA One in three patients with ischemic stroke during treatment with oral Xa inhibitors used inappropriate dose regimens. Underdosing was associated with lower functional plasma levels, higher clinical stroke severity and worse functional outcome.
Sections du résumé
BACKGROUND
BACKGROUND
Oral Factor Xa inhibitors for the prevention of stroke in atrial fibrillation require dose adjustment based on certain clinical criteria, but the off-label use of the reduced doses is common.
METHODS
METHODS
Data from an observational registry including patients admitted with acute cerebral ischemia while taking oral Factor Xa inhibitors for atrial fibrillation between April 2016 and December 2018 were investigated. The dose regimen of the Xa inhibitor was classified as "appropriate", "underdosed" and "overdosed" in conformity with the European Medicines Agency labelling. The effect of underdosing on the functional factor Xa plasma level on admission, the clinical stroke severity and the functional outcome after 3 months were investigated.
RESULTS
RESULTS
254 patients with cerebral ischemia while on Factor Xa inhibitors were included. The dose regimen of the Factor Xa inhibitor was appropriate in 166 patients (65%), underdosed in 67 patients (26%) and overdosed in 21 patients (8%). Underdosing was associated with female sex, diabetes mellitus and higher CHA
CONCLUSION
CONCLUSIONS
One in three patients with ischemic stroke during treatment with oral Xa inhibitors used inappropriate dose regimens. Underdosing was associated with lower functional plasma levels, higher clinical stroke severity and worse functional outcome.
Identifiants
pubmed: 32206901
doi: 10.1007/s00415-020-09795-3
pii: 10.1007/s00415-020-09795-3
pmc: PMC7320957
doi:
Substances chimiques
Factor Xa Inhibitors
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
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