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

• Published in: PloS one Vol. 9; no. 8; p. e101245
• Main Authors: Ho, Mei Han, Ho, Chi Wai, Cheung, Emmanuel, Chan, Pak Hei, Hai, Jo Jo, Chan, Koon Ho, Chan, Esther W, Leung, Gilberto Ka Kit, Tse, Hung Fat, Siu, Chung Wah
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.08.2014; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Analysis; Anticoagulants; Antithrombins - administration & dosage; Antithrombins - adverse effects; Antithrombins - therapeutic use; Atrial fibrillation; Atrial Fibrillation - complications; Audio frequencies; Benzimidazoles - administration & dosage; Benzimidazoles - adverse effects; Benzimidazoles - therapeutic use; beta-Alanine - administration & dosage; beta-Alanine - adverse effects; beta-Alanine - analogs & derivatives; beta-Alanine - therapeutic use; Bleeding; Cardiac arrhythmia; Cardiology; Care and treatment; Clinical medicine; Cost analysis; Dabigatran; Diabetes; Dyspepsia; FDA approval; Female; Fibrillation; Follow-Up Studies; Glomerular filtration rate; Heart failure; Hemorrhage; Hemorrhage - etiology; Hong Kong; Humans; Hypertension; Identification methods; Inhibitors; Ischemia; Male; Medical imaging; Medicine; Medicine and Health Sciences; Middle Aged; NMR; Nuclear magnetic resonance; Patients; Prevention; Proton pump inhibitors; Risk analysis; Risk Factors; Side effects; Stroke; Stroke - diagnosis; Stroke - etiology; Stroke - mortality; Stroke - prevention & control; Therapy; Thrombin; Tomography; Treatment Outcome; Warfarin; Hong Kong; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0101245

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. 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). Dabigatran discontinuation is very common amongst Chinese AF patients. This reveals a management gap in the prevention of stroke in AF.