Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention

Siedler G, Macha K, Stoll S, Plechschmidt J, Wang R, Gerner S, Strasser E, Schwab S, Kallmünzer B (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Journal of Thrombosis and Haemostasis Wiley-Blackwell

Abstract

Background: Patients with atrial fibrillation have a relevant risk for ischemic stroke despite the recommended use of direct oral anticoagulants (DOAC). The risk correlates with the functional DOAC plasma levels in clinical trials, but the value of their measurement in community use remains undetermined. Objectives: We aim to investigate the clinical implications and the prognostic value of DOAC plasma level measurement during steady state. Methods: In this observational clinical cohort study among patients with ischemic stroke and atrial fibrillation, 397 individuals on oral anticoagulants for secondary stroke prevention were included between 2016 and 2020. The functional DOAC plasma levels were measured during steady state. Early stroke recurrence within 3 months was recorded as the main outcome parameter. Results: Three hundred ninety-seven patients (201 female, mean age 78 [±9] years, median CHA2DS2VASc-Score 6 [interquartile range 5–7]) were included. Mean DOAC plasma trough level was 95.9 (±66.9) ng/ml. A high glomerular filtration rate (GFR) was an independent predictor of lower levels in a multivariate model (R coefficient: −0.174, P =.014). During follow-up, 10 patients (3%) suffered from early ischemic stroke recurrence despite the use of DOAC, while 10 clinically relevant bleeding complications occurred (3%). Ischemic stroke recurrence was associated with numerical lower plasma levels for patients on apixaban and dabigatran after propensity score matching. Conclusions: Monitoring of DOAC plasma levels could help to identify patients with increased risk for stroke recurrence and should be considered for certain subgroups, including patients with high GFR.

Authors with CRIS profile

Gabriela Siedler Department of Neurology Kosmas Macha Department of Neurology Svenja Kremer Professur für Stammzell-Modelle seltener neuraler Erkrankungen Johannes Plechschmidt Professur für Molekulare und Klinische Pharmazie Ruihao Wang Department of Neurology Stefan Gerner Department of Psychiatry and Psychotherapy Erwin Strasser Medizinische Fakultät Stefan Schwab Lehrstuhl für Neurologie Bernd Kallmünzer Medizinische Fakultät

How to cite

APA:

Siedler, G., Macha, K., Stoll, S., Plechschmidt, J., Wang, R., Gerner, S.,... Kallmünzer, B. (2022). Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention. Journal of Thrombosis and Haemostasis. https://dx.doi.org/10.1111/jth.15677

MLA:

Siedler, Gabriela, et al. "Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention." Journal of Thrombosis and Haemostasis (2022).

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