Despite the recommended use of direct oral anticoagulants, patients with atrial fibrillation have a significant risk of ischemic stroke. In clinical studies, the risk corresponds with functional DOAC plasma levels, but the usefulness of measuring them in community usage is unknown. As a result, Gabriela Siedler and colleagues carried out this investigation to evaluate the clinical consequences and prognostic usefulness of DOAC plasma level monitoring during a steady state.
Between 2016 and 2020, 397 people taking oral anticoagulants for secondary stroke prevention were enrolled in this observational clinical cohort research of patients with ischemic stroke and atrial fibrillation. During steady-state, the functional DOAC plasma levels were assessed. The key outcome indicator was early stroke recurrence within 3 months.
The key findings of this study were as follows:
1. Three hundred ninety-seven patients were included (201 females, mean age 78 [9] years, median CHA2DS2VASc-Score 6).
2. DOAC plasma trough level was 95.9 (66.9) ng/ml on average.
3. In a multivariate model, a high glomerular filtration rate was an independent predictor of lower levels (R coefficient: 0.174).
4. Despite the use of DOAC, 10 patients (3%) experienced early ischemic stroke recurrence during follow-up, and 10 clinically meaningful bleeding problems occurred (3% ).
5. After propensity score matching, ischemic stroke recurrence was linked with numerically reduced plasma levels in individuals on apixaban and dabigatran.
In conclusion, this investigation lacked the capacity to detect statistically significant differences between the single drugs. Larger, multi-center investigations should be launched to confirm the findings and study the substance-specific relationship. Furthermore, because no cerebral follow-up imaging was performed in this investigation, subclinical infarction was not observed.
Reference:
Siedler, G., Macha, K., Stoll, S., Plechschmidt, J., Wang, R., Gerner, S. T., Strasser, E., Schwab, S., & Kallmünzer, B. (2022). Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention. In Journal of Thrombosis and Haemostasis. Wiley. https://doi.org/10.1111/jth.15677
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.