Monitoring plasma levels of DOACs can help identify risk of stroke recurrence

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