Continuation of dabigatran therapy in "real-world" practice in Hong Kong
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...
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| Published in | PloS one Vol. 9; no. 8; p. e101245 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
01.08.2014
Public Library of Science (PLoS) |
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| Abstract | 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. |
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| AbstractList | Background 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. Methods and Results We studied 467 consecutive Chinese patients (72±11 years, male: 53.8%) with a mean CHA.sub.2 DS.sub.2 -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 H.sub.2 -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). Conclusion Dabigatran discontinuation is very common amongst Chinese AF patients. This reveals a management gap in the prevention of stroke in AF. Background 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. Methods and Results We studied 467 consecutive Chinese patients (72±11 years, male: 53.8%) with a mean CHA 2 DS 2 -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 H 2 -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). Conclusion Dabigatran discontinuation is very common amongst Chinese AF patients. This reveals a management gap in the prevention of stroke in AF. BACKGROUND: 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. METHODS AND RESULTS: 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). CONCLUSION: Dabigatran discontinuation is very common amongst Chinese AF patients. This reveals a management gap in the prevention of stroke in AF. Background 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. Methods and Results 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). Conclusion Dabigatran discontinuation is very common amongst Chinese AF patients. This reveals a management gap in the prevention of stroke in AF. 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 CHA.sub.2 DS.sub.2 -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 H.sub.2 -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. 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. |
| Audience | Academic |
| Author | Cheung, Emmanuel Chan, Pak Hei Leung, Gilberto Ka Kit Siu, Chung Wah Ho, Mei Han Hai, Jo Jo Tse, Hung Fat Ho, Chi Wai Chan, Esther W Chan, Koon Ho |
| AuthorAffiliation | 3 Department of Pharmacology and Pharmacy, the University of Hong Kong, Hong Kong SAR, China 4 Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China 1 Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China University of Bologna, Italy 2 Neurology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China |
| AuthorAffiliation_xml | – name: 1 Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China – name: 3 Department of Pharmacology and Pharmacy, the University of Hong Kong, Hong Kong SAR, China – name: 4 Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China – name: University of Bologna, Italy – name: 2 Neurology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China |
| Author_xml | – sequence: 1 givenname: Mei Han surname: Ho fullname: Ho, Mei Han organization: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China – sequence: 2 givenname: Chi Wai surname: Ho fullname: Ho, Chi Wai organization: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China – sequence: 3 givenname: Emmanuel surname: Cheung fullname: Cheung, Emmanuel organization: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China – sequence: 4 givenname: Pak Hei surname: Chan fullname: Chan, Pak Hei organization: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China – sequence: 5 givenname: Jo Jo surname: Hai fullname: Hai, Jo Jo organization: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China – sequence: 6 givenname: Koon Ho surname: Chan fullname: Chan, Koon Ho organization: Neurology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China – sequence: 7 givenname: Esther W surname: Chan fullname: Chan, Esther W organization: Department of Pharmacology and Pharmacy, the University of Hong Kong, Hong Kong SAR, China – sequence: 8 givenname: Gilberto Ka Kit surname: Leung fullname: Leung, Gilberto Ka Kit organization: Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China – sequence: 9 givenname: Hung Fat surname: Tse fullname: Tse, Hung Fat organization: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China – sequence: 10 givenname: Chung Wah surname: Siu fullname: Siu, Chung Wah organization: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25084117$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2014 Public Library of Science 2014 Ho et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2014 Ho et al 2014 Ho et al |
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| DOI | 10.1371/journal.pone.0101245 |
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| Notes | Conceived and designed the experiments: MHH CWH EC PHC JJH KHC EWC GL HFT CWS. Performed the experiments: MHH. Analyzed the data: MHH CWS. Contributed reagents/materials/analysis tools: HFT CWS. Wrote the paper: MHH CWH EC PHC JJH KHC EWC GL HFT CWS. Competing Interests: The authors have declared that no competing interests exist. |
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| References_xml | – volume: 217 start-page: 292 year: 2011 ident: ref9 article-title: Risk factors and incidence of ischemic stroke in Taiwanese with nonvalvular atrial fibrillation— a nation wide database analysis publication-title: Atherosclerosis doi: 10.1016/j.atherosclerosis.2011.03.033 contributor: fullname: LY Lin – volume: 34 start-page: 2091 year: 2003 ident: ref4 article-title: Proportion of different subtypes of stroke in China publication-title: Stroke doi: 10.1161/01.STR.0000087149.42294.8C contributor: fullname: LF Zhang – volume: 45 start-page: e43 year: 2014 ident: ref21 article-title: Response to letter regarding article, "dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in asians and non-asians with atrial fibrillation" publication-title: Stroke doi: 10.1161/STROKEAHA.113.002854 contributor: fullname: M Hori – volume: 139 start-page: 173 year: 2010 ident: ref8 article-title: Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese publication-title: Int J Cardiol doi: 10.1016/j.ijcard.2008.10.045 contributor: fullname: KL Chien – volume: 7 start-page: 155 year: 2014 ident: ref18 article-title: Dabigatran etexilate for secondary stroke prevention: the first year experience from a multicenter short-term registry publication-title: Ther Adv Neurol Disord doi: 10.1177/1756285614528064 contributor: fullname: G Tsivgoulis – volume: 58 start-page: 87 year: 2011 ident: ref10 article-title: Effect of herbal consumption on time in therapeutic range of warfarin therapy in patients with atrial fibrillation publication-title: J Cardiovasc Pharmacol doi: 10.1097/FJC.0b013e31821cd888 contributor: fullname: HT Chan – volume: 30(1) start-page: 58 year: 2014 ident: ref16 article-title: Efficacy and safety of novel anticoagulant dabigatran in clinical practice for Japanese patients with non-valvular atrial fibrillation publication-title: Journal of Arrhythmia doi: 10.1016/j.joa.2013.04.010 contributor: fullname: K Miyamoto – volume: 145 start-page: 247 year: 2006 ident: ref12 article-title: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate publication-title: ANNALS OF INTERNAL MEDICINE doi: 10.7326/0003-4819-145-4-200608150-00004 contributor: fullname: AS Levey – volume: 93 start-page: 483 year: 2007 ident: ref14 article-title: Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism publication-title: Heart doi: 10.1136/hrt.2006.100628 contributor: fullname: CW Siu – volume: 25 start-page: 304 year: 2011 ident: ref15 article-title: Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension publication-title: J Hum Hypertens doi: 10.1038/jhh.2010.57 contributor: fullname: LY Ho – volume: 289 start-page: 194 year: 2003 ident: ref13 article-title: Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic publication-title: JAMA doi: 10.1001/jama.289.2.194 contributor: fullname: MM Redfield – ident: ref20 doi: 10.1093/eurheartj/eht307.P549 – volume: 10(7) start-page: 1082 year: 2013 ident: ref7 article-title: Stroke Prevention in Atrial Fibrillation - An Asian Stroke Perspective publication-title: Heart Rhythm doi: 10.1016/j.hrthm.2013.03.017 contributor: fullname: HF Tse – volume: 38(1) start-page: 39 year: 2014 ident: ref22 article-title: A single centre experience of the efficacy and safety of dabigatran etexilate used for stroke prevention in atrial fibrillation publication-title: J Thromb Thrombolysis doi: 10.1007/s11239-013-1020-y contributor: fullname: LB Yap – volume: 22 start-page: 50 year: 2013 ident: ref23 article-title: Dabigatran for anticoagulation in atrial fibrillation - early clinical experience in a hospital population and comparison to trial data publication-title: Heart Lung Circ doi: 10.1016/j.hlc.2012.09.002 contributor: fullname: J Michel – volume: 12 start-page: 1360 year: 2010 ident: ref1 article-title: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) publication-title: Europace doi: 10.1093/europace/euq350 contributor: fullname: AJ Camm – volume: 128 start-page: 237 year: 2013 ident: ref19 article-title: The Long-Term Multicenter Observational Study of Dabigatran Treatment in Patients With Atrial Fibrillation (RELY-ABLE) Study publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.112.001139 contributor: fullname: SJ Connolly – volume: 379 start-page: 648 year: 2012 ident: ref2 article-title: Atrial fibrillation publication-title: Lancet doi: 10.1016/S0140-6736(11)61514-6 contributor: fullname: GY Lip – volume: 21 start-page: 230 year: 1990 ident: ref5 article-title: Cerebrovascular disease in Hong Kong Chinese publication-title: Stroke doi: 10.1161/01.STR.21.2.230 contributor: fullname: CY Huang – volume: 18 start-page: 988 year: 2012 ident: ref3 article-title: One-year clinical prediction in Chinese ischemic stroke patients using the CHADS2 and CHA2DS2-VASc scores: the China National Stroke Registry publication-title: CNS Neurosci Ther doi: 10.1111/cns.12021 contributor: fullname: SY Li – volume: 361 start-page: 1139 year: 2009 ident: ref11 article-title: Dabigatran versus warfarin in patients with atrial fibrillation publication-title: N Engl J Med doi: 10.1056/NEJMoa0905561 contributor: fullname: SJ Connolly – volume: 35 start-page: E40 year: 2012 ident: ref17 article-title: Dabigatran compared with warfarin for stroke prevention with atrial fibrillation: experience in Hong Kong publication-title: Clin Cardiol doi: 10.1002/clc.22069 contributor: fullname: JC Ho – volume: 17 start-page: 303 year: 2004 ident: ref6 article-title: Incidence of cerebral hemorrhage in the Changsha community. A prospective study from 1986 to 2000 publication-title: Cerebrovasc Dis contributor: fullname: QD Yang |
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| Snippet | Dabigatran, an oral direct thrombin inhibitor, possesses several advantages over warfarin that can in principle simplify the management of stroke prevention in... Background Dabigatran, an oral direct thrombin inhibitor, possesses several advantages over warfarin that can in principle simplify the management of stroke... BACKGROUND: Dabigatran, an oral direct thrombin inhibitor, possesses several advantages over warfarin that can in principle simplify the management of stroke... Background Dabigatran, an oral direct thrombin inhibitor, possesses several advantages over warfarin that can in principle simplify the management of stroke... |
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| SubjectTerms | 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 |
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| Title | Continuation of dabigatran therapy in "real-world" practice in Hong Kong |
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